新辅助化疗后前列腺特异膜抗原mRNA对前列腺癌盆腔淋巴结微转移的诊断价值
신보조화료후전렬선특이막항원mRNA대전렬선암분강림파결미전이적진단개치
The diagnostic value of prostatic specific membrane antigen mRNA in detecting prostate cancer pelvic lymph nodes micrometastasis after neoadjuvant hormonal therapy
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2013年 23期 1-4 ,共4页

    夏维木%刘定益%王健%王颖%王树军%唐崎%周燕峰%叶永峰%周文龙

    하유목%류정익%왕건%왕영%왕수군%당기%주연봉%협영봉%주문룡

    前列腺肿瘤%根治性前列腺切除术%淋巴结%微转移 前列腺腫瘤%根治性前列腺切除術%淋巴結%微轉移
    전렬선종류%근치성전렬선절제술%림파결%미전이
    Prostate neoplasms%Radical prostatectomy%Lymph nodes%Micrometastasis
    目的 明确新辅助化疗后前列腺特异膜抗原(PSMA)mRNA对前列腺癌盆腔淋巴结微转移的诊断价值.方法 对54例临床分期T2c～T3a期的前列腺癌患者,按照盆腔淋巴结情况分为病理阳性组、微转移阳性组、微转移阴性组,术前行足背淋巴管造影,对无明显淋巴结转移者行3个月新辅助化疗,根治性前列腺切除术前在X线监视下,对盆腔可疑癌转移淋巴结穿刺抽吸淋巴液,用实时定量聚合酶链反应(PCR)方法检测前列腺特异抗原(PSA) mRNA和PSMA mRNA的表达量,与同法抽取淋巴液的6例女性因膀胱癌行根治性膀胱切除术患者(对照组)检测结果进行比较.同时术中所取淋巴结组织切片行病理和免疫组织化学检查并进行比较.结果 病理阳性组6例14枚淋巴结中11枚淋巴结经病理证实发生转移,且PSA mRNA和PSMA mRNA均呈阳性表达.微转移阳性组12例31枚淋巴结病理检查证实均未发生转移,但其中27枚淋巴结PSA mRNA和PSMAmRNA呈阳性表达,另4枚为阴性表达.微转移阴性组36例111枚淋巴结病理检查和PSA mRNA、PSMA mRNA均呈阴性表达.病理阳性组与微转移阳性组术前淋巴液与术后淋巴结PSA mRNA相对表达量比较差异有统计学意义(0.3343±0.0288比0.2097±0.0235、0.2872±0.0291比0.1770±0.0222,P＜ 0.05),而PSMA mRNA相对表达量比较差异无统计学意义(0.6815±0.0621比0.6319±0.0331、0.6672±0.0673比0.6106±0.0916,P＞0.05).微转移阴性组与对照组术前淋巴液及术后淋巴结PSA mRNA和PSMA mRNA相对表达量比较差异均无统计学意义(微转移阴性组:0.0154±0.0015比0.0506±0.0034、0.0148±0.0054比0.0516±0.0058；对照组:0.0129±0.0015比0.0468±0.0033、0.0160±0.0003比0.0499±0.0009,P＞0.05).病理阳性组、微转移阳性组分别与微转移阴性组、对照组术前淋巴液及术后淋巴结PSA mRNA和PSMA mRNA相对表达量比较差异均有统计学意义(P＜0.05).微转移阴性组术前淋巴液与术后淋巴结PSMA mRNA相对表达量比较差异有统计学意义(P＜0.05).结论 前列腺癌患者经新辅助化疗后,由于病理检查有时难以发现变性的前列腺癌细胞以至于漏诊,采用实时定量PCR方法检测淋巴结抽吸液内PSA mRNA和PSMA mRNA表达量有利于探测前列腺癌新辅助化疗后淋巴结微转移的存在,PSMAmRNA可能是更为敏感的生物学标志物,为前列腺癌术前临床分期提供可靠的诊断依据.
    목적 명학신보조화료후전렬선특이막항원(PSMA)mRNA대전렬선암분강림파결미전이적진단개치.방법 대54례림상분기T2c～T3a기적전렬선암환자,안조분강림파결정황분위병리양성조、미전이양성조、미전이음성조,술전행족배림파관조영,대무명현림파결전이자행3개월신보조화료,근치성전렬선절제술전재X선감시하,대분강가의암전이림파결천자추흡림파액,용실시정량취합매련반응(PCR)방법검측전렬선특이항원(PSA) mRNA화PSMA mRNA적표체량,여동법추취림파액적6례녀성인방광암행근치성방광절제술환자(대조조)검측결과진행비교.동시술중소취림파결조직절편행병리화면역조직화학검사병진행비교.결과 병리양성조6례14매림파결중11매림파결경병리증실발생전이,차PSA mRNA화PSMA mRNA균정양성표체.미전이양성조12례31매림파결병리검사증실균미발생전이,단기중27매림파결PSA mRNA화PSMAmRNA정양성표체,령4매위음성표체.미전이음성조36례111매림파결병리검사화PSA mRNA、PSMA mRNA균정음성표체.병리양성조여미전이양성조술전림파액여술후림파결PSA mRNA상대표체량비교차이유통계학의의(0.3343±0.0288비0.2097±0.0235、0.2872±0.0291비0.1770±0.0222,P＜ 0.05),이PSMA mRNA상대표체량비교차이무통계학의의(0.6815±0.0621비0.6319±0.0331、0.6672±0.0673비0.6106±0.0916,P＞0.05).미전이음성조여대조조술전림파액급술후림파결PSA mRNA화PSMA mRNA상대표체량비교차이균무통계학의의(미전이음성조:0.0154±0.0015비0.0506±0.0034、0.0148±0.0054비0.0516±0.0058；대조조:0.0129±0.0015비0.0468±0.0033、0.0160±0.0003비0.0499±0.0009,P＞0.05).병리양성조、미전이양성조분별여미전이음성조、대조조술전림파액급술후림파결PSA mRNA화PSMA mRNA상대표체량비교차이균유통계학의의(P＜0.05).미전이음성조술전림파액여술후림파결PSMA mRNA상대표체량비교차이유통계학의의(P＜0.05).결론 전렬선암환자경신보조화료후,유우병리검사유시난이발현변성적전렬선암세포이지우루진,채용실시정량PCR방법검측림파결추흡액내PSA mRNA화PSMA mRNA표체량유리우탐측전렬선암신보조화료후림파결미전이적존재,PSMAmRNA가능시경위민감적생물학표지물,위전렬선암술전림상분기제공가고적진단의거.
    Objective To explore the evaluation of prostatic specific membrane antigen (PSMA)mRNA in detecting prostate cancer pelvic lymph nodes micrometastasis after neoadjuvant hormonal therapy (NHT).Methods Fifty-four patients of T2c-T3a prostate cancer were divided into positive pathology group,positive micrometastasis group,negative micrometastasis group.Six female cases who accepted radical cystectomy due to bladder cancer were as control group.Pedal lymphangiography was performed.NHT were administrated for 3 months in patients without lymph nodes metastasis.The level of prostate specific antigen (PSA) mRNA and PSMA mRNA in lymph fluid of the suspectable lymph nodes under the X-ray fluoroscope before radical prostatectomy(RP) were detected by quantitative real-time polymerase chain reaction PCR and compared.Furthermore,the lymph nodes pathology and immunohistology results were compared.Results Positive pathology group included 6 patients and 11 lymph nodes occurred metastasis in 14 lymph nodes.The expression of PSA mRNA and PSMA mRNA were positive.Positive micrometastasis group included 12patients,and had no lymph nodes metastasis in 31 lymph nodes.But the expression of PSA mRNA and PSMA mRNA were positive in 27 lymph nodes and negatively in 4 lymph nodes.Negative micrometastasis group included 36 patients and the expression of PSA mRNA and PSMA mRNA in 111 lymph nodes were negative.The level of PSA mRNA between preoperative lymph fluid and postoperative lymph nodes in positive pathology group and positive micrometastasis group had significant difference (0.3343 ± 0.0288 vs.0.2097 ±0.0235,0.2872 ±0.0291 vs.0.1770 ±0.0222,P ＜0.05).But the level of PSMA mRNA in positively pathology group and positive micrometastasis group had no significant difference (0.6815 ± 0.0621vs.0.6319 ± 0.0331,0.6672 ± 0.0673 vs.0.6106 ± 0.0916,P ＞ 0.05).The level of PSA mRNA and PSMAmRNA between preoperative lymph fluid and postoperative lymph nodes in negative micrometastasis group and control group had no significant difference(negative micrometastasis group:0.0154 ± 0.0015 vs.0.0506 ±0.0034,0.0148 ± 0.0054 vs.0.0516 ± 0.0058 ;control group:0.0129 ± 0.0015 vs.0.0468 ± 0.0033,0.0160 ±0.0003 vs.0.0499 ± 0.0009,P ＞ 0.05).The level of PSA mRNA and PSMA mRNA between preoperative lymph fluid and postoperative lymph nodes in positive pathology group and positive micrometastasis group had significant difference compared with negative micrometastasis group and control group (P ＜ 0.05).The level of PSMA mRNA in preoperative lymph fluid and postoperative lymph nodes in positive micrometastasis group had significant difference (P ＜ 0.05).Conclusions Although residual foci of atrophic prostate cancer cells in resected lymph nodes after NHT can be difficult to be diagnosed by pathological examination.The present results show the usefulness of quantitative real-time PCR targeting PSA and PSMA genes for detected micrometastatic tumour foci in pelvic lymph nodes from fine needle aspiration biopsy of lymph nodes before radical prostatectomy.The PSA mRNA and PSMA mRNA expression of the lymph fluid is preferred to diagnose the exist of lymph nodes micrometastasis after NHT.PSMA mRNA can be the best biomarker for early detection pelvic lymph nodes micrometastasis.This may provide the reliable diagnostic evidence for clinical stage before radical prostatectomy.
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