Korean J Urol.  2008 Jul;49(7):585-591.

Significance of Neuroendocrine Cell Differentiation in Specimens from Patients with Prostate Cancer

• Park CH
• Park CM
• Kim HK
• Gang KH
• Song JS
• Park JY

Abstract

PURPOSE: The neuroendocrine cell(NEC) is one of the constitutional cells found in the prostate gland; these cells secret neurotransmitters. These neuroendocrine products have been associated with prostate cancer progression. We evaluated the significance of neuroendocrine differentiation(NED) in radical prostatectomy specimens.
MATERIALS AND METHODS
We studied 45 patients who underwent bilateral pelvic lymphadenectomy and radical prostatectomy. The patients were classified into three groups according to their pathological stage. Group A included cases with organ confined tumors, Group B local advanced tumors and Group C cases had any T stage and lymph node metastasis. The cellular expression of chromogranin A in matched samples from the same patients was evaluated by immunohistochemical staining using commercially available monoclonal antibodies.
RESULTS
Sixteen(35.6%) tumors had chromogranin A stained cells. Chromogranin A immunoreactivity was greatest in cases with lymph node involvement(75.0%) compared to those with primary prostate cancer(5.9% in group A and 37.5% in group B). Pathologically advanced tumors or tumors with the highest histological grades were associated with increased NED. The median staining score was 0 in Group A, 0 in Group B and 1 in Group C. The logistic regression analysis the odds ratio for group C cases showed a relative risk of 32.07(95% CI: 2.783-369.416) for NED compared to Group A. An increased prostate-specific antigen(PSA) and Gleason score were also associated with the NED.
CONCLUSIONS
The degree of NEC immunohistochemical staining using the chromogranin A monoclonal antibody was marginally useful for predicting the outcome in prostate cancer patients after radical prostatectomy, especially in node positive patients. However, it is important to determine a therapeutic plan for patients with low PSA and internal organ metastasis.

Keyword

Prostate cancer; Neuroendocrine differentiation; Prognosis

MeSH Terms

Antibodies, Monoclonal
Chromogranin A
Humans
Logistic Models
Lymph Node Excision
Lymph Nodes
Neoplasm Grading
Neoplasm Metastasis
Neuroendocrine Cells
Neurotransmitter Agents
Odds Ratio
Prognosis
Prostate
Prostatectomy
Prostatic Neoplasms
Antibodies, Monoclonal
Chromogranin A
Neurotransmitter Agents

Figure

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  Fig. 1. (A) The findings with a neuroendocrine differentiation score of 1 (stained cells ＜10%). Immunoreactive neoplastic cells are scattered (x100). (B) The findings with a neuroendocrine differentiation score of 3 (stained cell ＞20%). Numerous cancer cells with immunoreactivity were identified.

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  Fig. 2. (A) Relationship between neuroendocrine differentiation and clinical stage (by ANOVA test). (B) Relationship between neuroendocrine differentiation and histological grade (by Student’s t-test).

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