Shariat Shahrokh F, Kim JaHong, Nguyen Cuong, Wheeler Thomas M, Lerner Seth P, Slawin Kevin M
Baylor Prostate Center, Scott Department of Urology, Baylor College of Medicine, and Methodist Hospital, Houston, Texas 77030-2706, USA.
Urology. 2003 Feb;61(2):359-64. doi: 10.1016/s0090-4295(02)02253-7.
To test the hypothesis that plasma insulin growth factor (IGF)-I or IGF binding protein (BP)-3 levels would differ between patients with bladder cancer and healthy controls and whether preoperative plasma IGF-I or IGFBP-3 could predict the pathologic characteristics and clinical outcome of patients with bladder cancer undergoing radical cystectomy. The IGFs are mitogens that have been shown to play a significant role in regulating proliferation and differentiation of bladder cancer cells.
The study group consisted of 51 patients who underwent radical cystectomy (median follow-up 45.7 months). The preoperative plasma levels of IGF-I and IGFBP-3 were measured using DSL-enzyme-linked immunosorbent assays. The IGF-I and IGFBP-3 levels were also measured in 44 healthy men.
The plasma IGF-I and IGFBP-3 levels in patients with bladder cancer were not significantly different from those in healthy subjects (P >or=0.339). In a preoperative model that included clinical grade, clinical stage, and either IGF-I or IGFBP-3, none of the parameters was associated with either metastases to lymph nodes or clinical outcome. However, in an alternative model that included both IGF-I and IGFBP-3 in addition to clinical stage and grade, only a lower preoperative plasma IGFBP-3 level was associated with metastases to regional lymph nodes, bladder cancer progression, and survival (P = 0.047, 0.050, and 0.040, respectively).
We found no association between preoperative plasma IGF-I and bladder cancer characteristics or outcome, limiting the clinical utility of IGF-I. In contrast, a lower preoperative plasma level of IGFBP-3 was associated with lymph node metastasis and poorer clinical outcome after radical cystectomy when adjusted for IGF-I level.
检验以下假设，即膀胱癌患者与健康对照者的血浆胰岛素样生长因子（IGF）-I或IGF结合蛋白（BP）-3水平存在差异，以及术前血浆IGF-I或IGFBP-3能否预测接受根治性膀胱切除术的膀胱癌患者的病理特征和临床结局。IGF是有丝分裂原，已证明其在调节膀胱癌细胞的增殖和分化中起重要作用。
研究组由51例行根治性膀胱切除术的患者组成（中位随访时间45.7个月）。采用DSL酶联免疫吸附测定法测量术前血浆IGF-I和IGFBP-3水平。还对44名健康男性测量了IGF-I和IGFBP-3水平。
膀胱癌患者的血浆IGF-I和IGFBP-3水平与健康受试者相比无显著差异（P≥0.339）。在一个包括临床分级、临床分期以及IGF-I或IGFBP-3的术前模型中，没有任何参数与淋巴结转移或临床结局相关。然而，在一个除临床分期和分级外还包括IGF-I和IGFBP-3的替代模型中，只有术前血浆IGFBP-3水平较低与区域淋巴结转移、膀胱癌进展和生存相关（分别为P = 0.047、0.050和0.040）。
我们发现术前血浆IGF-I与膀胱癌特征或结局之间无关联，限制了IGF-I的临床应用价值。相比之下，调整IGF-I水平后，术前血浆IGFBP-3水平较低与根治性膀胱切除术后的淋巴结转移及较差的临床结局相关。
