Thomas John, Gupta Manjula, Grasso Ying, Reddy Chandana A, Heston Warren D, Zippe Craig, Dreicer Robert, Kupelian Patrick A, Brainard Jennifer, Levin Howard S, Klein Eric A
Urological Institute, Taussig Cancer Center, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Clin Oncol. 2002 Aug 1;20(15):3213-8. doi: 10.1200/JCO.2002.11.097.
We report a prospective study examining the ability of preoperative nested reverse transcriptase polymerase chain reaction (RT-PCR) for prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSM) to predict pathologic stage and biochemical recurrence in patients with clinically localized prostate cancer treated with radical prostatectomy.
One hundred forty-one patients were entered onto the study. Preoperative evaluation included clinical T stage, serum PSA, biopsy Gleason score, and serum RT-PCR for PSA/PSM. Univariate and multivariate logistic regression models, Kaplan-Meier estimates, and Cox proportional hazards modeling were used to identify predictors of pathologic stage and biochemical failure.
Seventy-three patients (51.8%) were RT-PCR positive for PSA, PSM, or both. In the multivariate logistic regression model, only initial PSA was an independent predictor of pathologic stage as defined by organ-confined disease (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00 to 1.13; P =.026) or organ-/specimen-confined disease (OR, 1.09; 95% CI, 1.02 to 1.16; P =.009). Overall Kaplan-Meier biochemical relapse-free survival (bRFS) was 85% at 59 months. Multivariate analysis of predictors for bRFS with the Cox proportional hazards model indicated that only initial PSA (OR, 1.05; 95% CI, 1.02 to 1.09; P =.004) and biopsy Gleason score (OR, 3.57; 95% CI, 1.37 to 9.58; P =.009) were independent predictors of biochemical failure. RT-PCR status did not predict pathologic stage or biochemical failure. Repeat analysis excluding 27 patients who received preoperative androgen-deprivation therapy did not change the results.
Combined nested RT-PCR for PSA and PSM is not an independent predictor of pathologic stage or biochemical failure in patients with localized prostate cancer undergoing radical prostatectomy. This assay has no clinical utility in this patient population.
我们报告一项前瞻性研究，该研究检测术前巢式逆转录酶聚合酶链反应（RT-PCR）检测前列腺特异性抗原（PSA）和前列腺特异性膜抗原（PSM）的能力，以预测接受根治性前列腺切除术治疗的临床局限性前列腺癌患者的病理分期和生化复发情况。
141例患者纳入本研究。术前评估包括临床T分期、血清PSA、活检Gleason评分以及血清PSA/PSM的RT-PCR检测。采用单因素和多因素逻辑回归模型、Kaplan-Meier估计法以及Cox比例风险模型来确定病理分期和生化失败的预测因素。
73例患者（51.8%）PSA、PSM或两者的RT-PCR检测呈阳性。在多因素逻辑回归模型中，仅初始PSA是器官局限性疾病（比值比[OR]，1.06；95%置信区间[CI]，1.00至1.13；P = 0.026）或器官/标本局限性疾病（OR，1.09；95% CI，1.02至1.16；P = 0.009）所定义的病理分期的独立预测因素。总体Kaplan-Meier生化无复发生存期（bRFS）在59个月时为85%。采用Cox比例风险模型对bRFS的预测因素进行多因素分析表明，仅初始PSA（OR，1.05；95% CI，1.02至1.09；P = 0.004）和活检Gleason评分（OR，3.57；95% CI，1.37至9.58；P = 0.009）是生化失败的独立预测因素。RT-PCR状态不能预测病理分期或生化失败。排除27例接受术前雄激素剥夺治疗的患者后进行重复分析，结果未改变。
对于接受根治性前列腺切除术的局限性前列腺癌患者，联合巢式RT-PCR检测PSA和PSM并非病理分期或生化失败的独立预测因素。该检测方法在这一患者群体中无临床应用价值。
