Liersch T, Gatzemeier W, Scharnberg P, Jürgens B, Wörmann B, Becker H, Rauschecker H F, Hiddemann W, Wulf G G
Abt. Allgemeinchirurgie, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen.
Langenbecks Arch Chir Suppl Kongressbd. 1998;115(Suppl I):277-80.
The analysis of tissue specific gene expression by reverse transcription based RT/PCR methods is currently evaluated as a method for the detection of tumor cell dissemination in patients with cancer. Breast cancer tissues express PTHrP and the level of PTHrP expression in the primary tumor correlates with the incidence of metastases in the bone. We applied a RT/PCR assay of PTHrP to detect tumor cells in the mononuclear cell fraction of peripheral blood (pb) and bone marrow (bm) of patients with newly diagnosed breast cancer. PTHrP positivity was found in 18/67 pb and 20/71 bm samples. In a median follow up of 23 months there were 7 metastatic relapses (4 osseous, 2 hepatic, 1 pulmonary) and 9 local relapses in patients with primary lymph node positive breast cancer. The hepatic and pulmonary relapses had been both PTHrP-PCR negative in pb and in bm. Of the 4 patients with metastatic relapses to the bone the samples of bm had been initially negative in all cases, the pb had been positive in 2 cases. Of the 9 patients with local recurrences the pb alone had been positive in 4 patients, 5 patients had been negative in both the pb and the bm. During the period of observation there was no local and metastatic relapse detectable in the group of patients with primary lymph node negative breast cancer. In summary the increased risk for local or systemic relapse would have been predictable by RT/PCR of PTHrP alone in pb in 4 of the 9 local and in 2 of the 7 early metastatic relapses. Further follow-up of the patient cohort analysed is needed to assess the value of the RT/PCR of PTHrP as a prognostic and predictive marker in patients with breast cancer.
目前，基于逆转录的RT/PCR方法对组织特异性基因表达的分析被评估为一种检测癌症患者肿瘤细胞播散的方法。乳腺癌组织表达甲状旁腺激素相关蛋白（PTHrP），原发肿瘤中PTHrP的表达水平与骨转移的发生率相关。我们应用PTHrP的RT/PCR检测方法来检测新诊断乳腺癌患者外周血（pb）和骨髓（bm）单核细胞部分中的肿瘤细胞。在67份pb样本中有18份、71份bm样本中有20份检测到PTHrP阳性。在中位随访23个月期间，原发性淋巴结阳性乳腺癌患者中有7例发生转移性复发（4例骨转移、2例肝转移、1例肺转移）和9例局部复发。肝转移和肺转移患者的pb和bm样本PTHrP-PCR检测均为阴性。4例发生骨转移复发的患者中，所有病例的bm样本最初均为阴性，2例pb样本为阳性。9例局部复发患者中，仅pb样本阳性的有4例，pb和bm样本均阴性的有5例。在观察期内，原发性淋巴结阴性乳腺癌患者组未检测到局部和转移性复发。总之，在9例局部复发患者中的4例以及7例早期转移性复发患者中的2例中，仅通过pb中PTHrP的RT/PCR检测就可预测局部或全身复发风险增加。需要对所分析的患者队列进行进一步随访，以评估PTHrP的RT/PCR作为乳腺癌患者预后和预测标志物的价值。
