Karam Jose A, Svatek Robert S, Karakiewicz Pierre I, Gallina Andrea, Roehrborn Claus G, Slawin Kevin M, Shariat Shahrokh F
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Clin Cancer Res. 2008 Mar 1;14(5):1418-22. doi: 10.1158/1078-0432.CCR-07-0901.
Current predictive tools and imaging modalities are not accurate enough to preoperatively diagnose lymph node metastases in patients with prostate cancer. The aim of the study was to evaluate whether preoperative plasma endoglin improves the prediction of lymph node metastases in patients with clinically localized prostate cancer.
Endoglin levels were measured using a commercially available ELISA assay in banked plasma from 425 patients treated with radical prostatectomy and bilateral lymphadenectomy for clinically localized prostatic adenocarcinoma at two university hospitals between July 1994 and November 1997. Logistic regression analyses were undertaken to evaluate whether endoglin improves the accuracy of a standard preoperative model for prediction of lymph node metastasis and to build a predictive nomogram.
Preoperative plasma endoglin levels were higher in patients with higher preoperative total serum prostate-specific antigen (PSA; Spearman correlation coefficient 0.296, P < 0.001), positive surgical margins (P = 0.03), higher pathologic Gleason sum (P = 0.04), and lymph node metastasis (P < 0.001). In a preoperative multivariable logistic regression analysis that included PSA and clinical stage, only preoperative endoglin (odds ratio, 1.17; 95% confidence interval, 1.09-1.26; P < 0.001) and biopsy Gleason sum (odds ratio, 18.57; 95% confidence interval, 1.08-318.36; P = 0.04) were associated with metastasis to lymph nodes. The addition of endoglin to a standard preoperative model (including PSA, clinical stage, and biopsy Gleason sum) significantly improved its accuracy for prediction of lymph node metastasis from 89.4% to 97.8% (P < 0.001).
Preoperative plasma endoglin improves the accuracy for prediction of pelvic lymph node metastasis in patients treated with radical prostatectomy for clinically localized prostate cancer by a statistically and clinically significant margin.
目前的预测工具和成像方式在术前诊断前列腺癌患者的淋巴结转移方面不够准确。本研究的目的是评估术前血浆内皮糖蛋白是否能改善临床局限性前列腺癌患者淋巴结转移的预测。
在1994年7月至1997年11月期间，于两家大学医院对425例因临床局限性前列腺腺癌接受根治性前列腺切除术和双侧淋巴结清扫术的患者，使用市售酶联免疫吸附测定法检测其储存血浆中的内皮糖蛋白水平。进行逻辑回归分析，以评估内皮糖蛋白是否能提高预测淋巴结转移的标准术前模型的准确性，并构建预测列线图。
术前总血清前列腺特异性抗原水平较高的患者（Spearman相关系数0.296，P < 0.001）、手术切缘阳性（P = 0.03）、病理Gleason评分较高（P = 0.04）和有淋巴结转移的患者（P < 0.001），其术前血浆内皮糖蛋白水平较高。在一项包括前列腺特异性抗原和临床分期的术前多变量逻辑回归分析中，只有术前内皮糖蛋白（比值比，1.17；95%置信区间，1.09 - 1.26；P < 0.001）和活检Gleason评分（比值比，18.57；95%置信区间，1.08 - 318.36；P = 0.04）与淋巴结转移相关。将内皮糖蛋白添加到标准术前模型（包括前列腺特异性抗原、临床分期和活检Gleason评分）中，显著提高了其预测淋巴结转移的准确性，从89.4%提高到97.8%（P < 0.001）。
术前血浆内皮糖蛋白能显著提高临床局限性前列腺癌患者接受根治性前列腺切除术后盆腔淋巴结转移预测的准确性，具有统计学和临床意义。
