Qingfu Zhang1, Yunan Han2,3, Yao Zhang1, Dan Liu1, Jian Ming4, Bo Huang5, Xueshan Qiu1. 1. Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China. 2. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States. 3. Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. 4. Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China. 5. Department of Pathology, The Liaoning Cancer Hospital & Institute of China Medical University, Shenyang, China.
Abstract
PURPOSE: This study aimed to evaluate the pathological characteristics, immunophenotype, and prognosis of treatment-emergent neuroendocrine prostate cancer (T-NEPC). MATERIALS AND METHODS: We collected 231 repeated biopsy specimens of castration-resistant prostate cancer (CRPC) cases between 2008 and 2019. We used histopathological and immunohistochemical evaluations of Synaptophysin (SYN), ChromograninA (CgA), CD56, androgen receptor (AR), and prostate-specific antigen (PSA) to screen out T-NEPC cases. Multivariate analyses were performed to identify factors in the prognosis of T-NEPC. Further, the results were verified in the Surveillance, Epidemiology, and End Results (SEER) program. RESULTS: Among the 231 CRPC cases, 94 (40.7%) cases were T-NEPC. T-NEPC were more likely to present with negative immunohistochemistry for AR (30.9%) and PSA (47.9%) than that of CRPC (8.8% and 17.5%, respectively). Kaplan-Meier analysis revealed that patients with T-NEPC (median overall survival [OS]: 17.6 months, 95% CI: 15.3-19.9 months) had significantly worse survival compared with usual CRPC patients (median OS: 23.6 months, 95% CI: 21.3-25.9 months, log-rank P = 0.001), especially in metastasis cases (median OS: 15.7 months, 95% CI: 13.3-18.0 months) and patients with small cell carcinoma component (median OS: 9.7 months, 95% CI: 8.2-11.2 months). Prostate adenocarcinoma with diffuse NE differentiation (median OS: 18.8 months, 95% CI: 15.3-22.3 months) had poor outcome than those with usual CRPC (P = 0.027), while there was no significant change in the focal NE differentiation (median OS: 22.9 months, 95% CI: 18.1-27.7 months, P = 0.136). In the unadjusted model, an excess risk of overall death was observed in T-NEPC with PSA negative (HR = 2.86, 95% CI = 1.39-6.73). Among 476 NEPC cases in the SEER database from 2004 to 2017, we observed a higher hazard of overall death in patients aged 65 years and older (HR = 1.35, 95% CI = 1.08-1.69), patients with PSA ≤ 2.5 ng/ml (HR = 1.90, 95%CI = 1.44-2.52), patients with PSA 2.6-4.0 ng/ml (HR = 2.03, 95%CI = 1.38-2.99), stage IV tumor (HR = 2.13, 95%CI = 1.47-3.08) and other races (HR = 1.85, 95%CI = 1.17-2.94) in total NEPC, adjusting for confounders. Similar hazard ratios were observed in pure NEPC, while there was no significant results among prostate adenocarcinoma with NE differentiation tumors. CONCLUSION: T-NEPC was associated with an unfavorable prognosis, negative immunohistochemistry for PSA in T-NEPC and serum PSA level ≤ 4 ng/ml had a worse prognosis. Urologists and pathologists should recognize the importance of the second biopsy in CRPC to avoid unnecessary diagnosis and treatment delays.
PURPOSE: This study aimed to evaluate the pathological characteristics, immunophenotype, and prognosis of treatment-emergent neuroendocrine prostate cancer (T-NEPC). MATERIALS AND METHODS: We collected 231 repeated biopsy specimens of castration-resistant prostate cancer (CRPC) cases between 2008 and 2019. We used histopathological and immunohistochemical evaluations of Synaptophysin (SYN), ChromograninA (CgA), CD56, androgen receptor (AR), and prostate-specific antigen (PSA) to screen out T-NEPC cases. Multivariate analyses were performed to identify factors in the prognosis of T-NEPC. Further, the results were verified in the Surveillance, Epidemiology, and End Results (SEER) program. RESULTS: Among the 231 CRPC cases, 94 (40.7%) cases were T-NEPC. T-NEPC were more likely to present with negative immunohistochemistry for AR (30.9%) and PSA (47.9%) than that of CRPC (8.8% and 17.5%, respectively). Kaplan-Meier analysis revealed that patients with T-NEPC (median overall survival [OS]: 17.6 months, 95% CI: 15.3-19.9 months) had significantly worse survival compared with usual CRPC patients (median OS: 23.6 months, 95% CI: 21.3-25.9 months, log-rank P = 0.001), especially in metastasis cases (median OS: 15.7 months, 95% CI: 13.3-18.0 months) and patients with small cell carcinoma component (median OS: 9.7 months, 95% CI: 8.2-11.2 months). Prostate adenocarcinoma with diffuse NE differentiation (median OS: 18.8 months, 95% CI: 15.3-22.3 months) had poor outcome than those with usual CRPC (P = 0.027), while there was no significant change in the focal NE differentiation (median OS: 22.9 months, 95% CI: 18.1-27.7 months, P = 0.136). In the unadjusted model, an excess risk of overall death was observed in T-NEPC with PSA negative (HR = 2.86, 95% CI = 1.39-6.73). Among 476 NEPC cases in the SEER database from 2004 to 2017, we observed a higher hazard of overall death in patients aged 65 years and older (HR = 1.35, 95% CI = 1.08-1.69), patients with PSA ≤ 2.5 ng/ml (HR = 1.90, 95%CI = 1.44-2.52), patients with PSA 2.6-4.0 ng/ml (HR = 2.03, 95%CI = 1.38-2.99), stage IV tumor (HR = 2.13, 95%CI = 1.47-3.08) and other races (HR = 1.85, 95%CI = 1.17-2.94) in total NEPC, adjusting for confounders. Similar hazard ratios were observed in pure NEPC, while there was no significant results among prostate adenocarcinoma with NE differentiation tumors. CONCLUSION: T-NEPC was associated with an unfavorable prognosis, negative immunohistochemistry for PSA in T-NEPC and serum PSA level ≤ 4 ng/ml had a worse prognosis. Urologists and pathologists should recognize the importance of the second biopsy in CRPC to avoid unnecessary diagnosis and treatment delays.
Authors: Rahul Aggarwal; Jiaoti Huang; Joshi J Alumkal; Li Zhang; Felix Y Feng; George V Thomas; Alana S Weinstein; Verena Friedl; Can Zhang; Owen N Witte; Paul Lloyd; Martin Gleave; Christopher P Evans; Jack Youngren; Tomasz M Beer; Matthew Rettig; Christopher K Wong; Lawrence True; Adam Foye; Denise Playdle; Charles J Ryan; Primo Lara; Kim N Chi; Vlado Uzunangelov; Artem Sokolov; Yulia Newton; Himisha Beltran; Francesca Demichelis; Mark A Rubin; Joshua M Stuart; Eric J Small Journal: J Clin Oncol Date: 2018-07-09 Impact factor: 44.544
Authors: Iris D Nagtegaal; Robert D Odze; David Klimstra; Valerie Paradis; Massimo Rugge; Peter Schirmacher; Kay M Washington; Fatima Carneiro; Ian A Cree Journal: Histopathology Date: 2019-11-13 Impact factor: 5.087