Abstract
BackgroundNeuroendocrine carcinoma (NEC) is a rare and highly malignant variation of prostate adenocarcinoma. We aimed to investigate the prognostic value of NEC in prostate cancer.MethodsA total of 530440 patients of prostate cancer, including neuroendocrine prostate cancer (NEPC) and adenocarcinoma from 2004 to 2018 were obtained from the national Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM), multivariable Cox proportional hazard model, Kaplan‐Meier method and subgroup analysis were performed in our study.ResultsNEPC patients were inclined to be older at diagnosis (Median age, 69(61-77) vs. 65(59-72), P< 0.001) and had higher rates of muscle invasive disease (30.9% vs. 9.2%, P < 0.001), lymph node metastasis (32.2% vs. 2.2%, P < 0.001), and distal metastasis (45.7% vs. 3.6%, P < 0.001) compared with prostate adenocarcinoma patients. However, the proportion of NEPC patients with PSA levels higher than 4.0 ng/mL was significantly less than adenocarcinoma patients (47.3% vs. 72.9%, P<0.001). NEPC patients had a lower rate of receiving surgery treatment (28.8% vs. 43.9%, P<0.001), but they had an obviously higher rate of receiving chemotherapy (57.9% vs. 1.0%, P<0.001). A Cox regression analysis demonstrated that the NEPC patients faced a remarkably worse OS (HR = 2.78, 95% CI = 2.34–3.31, P < 0.001) and CSS (HR = 3.07, 95% CI = 2.55–3.71, P < 0.001) compared with adenocarcinoma patients after PSM. Subgroup analyses further suggested that NEPC patients obtained significantly poorer prognosis across nearly all subgroups.ConclusionThe prognosis of NEPC was worse than that of adenocarcinoma among patients with prostate cancer. The histological subtype of NEC is an independent prognostic factor for patients with prostate cancer.
Highlights
Prostate cancer, has the highest incidence of malignancy among men in the United States in 2021, which accounts for 26% of diagnoses [1, 2]
The results demonstrated that Neuroendocrine carcinoma (NEC) patients obtained significantly poorer prognosis than adenocarcinoma patients across all subgroups except for G2 (HR = 3.25, 95%CI=0.68–15.4, P=0.1371), stage II (HR = 2.56, 95%CI=0.64–10.2, P=0.1831) and lymph nodes negative (HR = 3.57, 95%CI=0.94–13.4, P=0.0602) subgroups
The results uncovered that Neuroendocrine prostate cancer (NEPC) patients had a poorer survival outcome out of all subgroups. These results indicated that among patients with prostate cancer, the histological subtype of NEC had poorer prognosis than adenocarcinoma, which was not affected by other potential variates
Summary
Prostate cancer, has the highest incidence of malignancy among men in the United States in 2021, which accounts for 26% of diagnoses [1, 2]. It is the second leading cause of cancer related deaths, only behind lung cancer [1]. Neuroendocrine carcinoma (NEC) is a rare histological type, accounting for approximately 1% of newly diagnosed prostate cancer [4]. Neuroendocrine prostate cancer (NEPC) possesses highly malignant characteristics such as poorly differentiated and high-grade [3, 5]. Neuroendocrine carcinoma (NEC) is a rare and highly malignant variation of prostate adenocarcinoma. We aimed to investigate the prognostic value of NEC in prostate cancer
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