攝護腺癌遠端轉移位置之分析: 單一醫院病例9年經驗
方楚文1、劉建良1、黃冠華1、沈坤宏1、蘇家震1、王致丞1、李高漢1、謝昆霖1、林奎利2、麥志輝3
1奇美醫療財團法人奇美醫學中心外科部泌尿外科, 2放射腫瘤部, 3影像醫學部
Distal Metastases from Prostate Cancer: 9-year Experience of a Single Institution
Chu-Wen Fang1, Chien Liang Liu1, Steven Kuan-Hua Huang1, Kun-Hung Shen1, Chia-Cheng Su1, Jhih-Cheng Wang1, Kau-Han Lee1, Kun-Lin Hsieh1, Kuei-Li Lin2, Chee-Wai Mak3
1Division of Urology, Department of Surgery, 2Department of Radiation Oncology, and 3Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
Purpose
The purpose of the study was to retrospectively review the frequency, sites, and patterns of distal metastases (M1a-M1c) from prostate cancer, and to determine whether any correlation exists between the distal sites and histologic variables.
Materials & Methods
From 2007 to 2015, total 1239 patients with biopsy-proven prostate carcinoma were diagnosed in our institute. Total 267 patients with distal sites (M1) of metastases were identified. Among 267 patients, 165 patients who have only bone metastases were excluded. Then, all available imaging studies of remaining 102 patients were reviewed. Patients were separated into groups on the basis of the presence or absence of concurrent osseous metastasis and high or low Gleason grade, and metastatic patterns were compared using the Fisher exact test.
Results
The most frequent sites of distal metastases were the bone metastases. After exclusion of the 165 patients who have only bone metastases, the most frequent sites of distal metastases were the para-aortic lymph nodes, osseous metastases, common iliac lymph nodes, lungs and pleura, inguinal lymph nodes, and liver. The most commonly non-regional involved nodes were para-aortic lymph nodes, common iliac lymph nodes, inguinal lymph nodes, and mediastinal lymph nodes. The most common sites of extranodal metastases were the lung and pleura, liver, and brain(3/102). There is no significant correlation between distal metastatic pattern and osseous metastases. Supradiaphragmatic lymph nodes metastasis occurred more frequently in patients with a high Gleason grade than in patients with a low Gleason grade.
Conclusion
The data demonstrate that para-aortic lymph nodes, osseous metastases, common iliac lymph nodes, lungs and pleura, inguinal lymph nodes, liver are the most common distal metastatic sites of prostate cancer. Supradiaphragmatic lymph nodes metastasis occurred more frequently in patients with a high Gleason grade than in patients with a low Gleason grade.