Abaza Ronney, Diaz Leslie K, Laskin William B, Pins Michael R
Department of Pathology, Northwestern University Medical School, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
J Urol. 2006 Dec;176(6 Pt 1):2701-5. doi: 10.1016/j.juro.2006.07.133.
Discovery of prostatic adenocarcinoma limited to transurethral resection material generates a treatment dilemma. We investigated the usefulness of parameters shown to be associated with prognosis in prostate cancer (p53 and bcl-2 immuno-expression, DNA cell cycle analysis and Gleason score) to stratify these incidentally identified tumors to guide clinical decision making.
Paraffin embedded tissues from transurethral prostate resection specimens containing T1a prostate adenocarcinoma from 44 patients who underwent resection between 1980 and 1990 were immunostained for p53 and bcl-2, and subjected to flow cytometry to determine DNA ploidy. Gleason score was determined by 2 pathologists independently. Statistical relationships among these 4 variables, tumor progression and cancer specific survival were analyzed.
Six of 44 patients in the study population had cancer progression. Time to clinical progression was 4.5 years (range 7 months to 11 years). Most tumors stained negative for p53 and bcl-2. Only 2 tumors studied were aneuploid and neither of these 2 patients had cancer progression. Only Gleason score was a significant predictor of cancer progression on univariate and multivariate Cox regression analysis (p = 0.045 and 0.046, respectively). No tumor characteristics correlated with time to disease progression, including p53 and bcl-2 immuno-expression, and Gleason score (p = 0.182, 0.563 and 0.346, respectively). Positive immunostaining for p53 and bcl-2 did not occur together in the same tumor in significant fashion (p = 0.334), nor did either significantly occur more with aneuploidy (p = 0.237 and 0.307 respectively).
For T1a prostate cancer incidentally detected on transurethral prostate resection p53 and bcl-2 immuno-expression, and DNA ploidy do not predict survival or disease progression.
局限于经尿道切除标本的前列腺腺癌的发现带来了治疗难题。我们研究了已显示与前列腺癌预后相关的参数（p53和bcl-2免疫表达、DNA细胞周期分析和Gleason评分）对这些偶然发现的肿瘤进行分层以指导临床决策的有用性。
对1980年至1990年间接受经尿道前列腺切除术的44例患者的经尿道前列腺切除标本中含T1a前列腺腺癌的石蜡包埋组织进行p53和bcl-2免疫染色，并进行流式细胞术以确定DNA倍体。Gleason评分由2名病理学家独立确定。分析这4个变量、肿瘤进展和癌症特异性生存之间的统计关系。
研究人群中的44例患者中有6例出现癌症进展。临床进展时间为4.5年（范围7个月至11年）。大多数肿瘤p53和bcl-2染色为阴性。仅2例研究的肿瘤为非整倍体，这2例患者均未出现癌症进展。在单变量和多变量Cox回归分析中，只有Gleason评分是癌症进展的显著预测因子（分别为p = 0.045和0.046）。没有肿瘤特征与疾病进展时间相关，包括p53和bcl-2免疫表达以及Gleason评分（分别为p = 0.182、0.563和0.346）。p53和bcl-2的阳性免疫染色在同一肿瘤中未以显著方式同时出现（p = 0.334），二者与非整倍体的显著关联也均未出现（分别为p = 0.237和0.307）。
对于经尿道前列腺切除术中偶然发现的T1a前列腺癌，p53和bcl-2免疫表达以及DNA倍体不能预测生存或疾病进展。
