Ather M Hammad, Abbas Farhat, Faruqui Nuzhat, Israr Mohammad, Pervez Shahid
Department of Surgery, Aga Khan University, Karachi, Pakistan.
BMC Urol. 2008 Dec 30;8:21. doi: 10.1186/1471-2490-8-21.
The importance of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade is gaining acceptance. There is limited literature on the relative significance of three commonly used markers of NE differentiation i.e. Chromogranin A (CgA), Neuron specific enolase (NSE) and Synaptophysin (Syn). In the current work we have assessed the correlation of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade and to determine the relative value of various markers.
Consecutive samples of malignant prostatic specimens (Transurethral resection of prostate or radical retropubic prostatectomy) from 84 patients between January 1991 and December 1998 were evaluated by immunohistochemical staining (PAP technique) using selected neuroendocrine tumor markers i.e. Chromogranin A (CgA), Neuron specific enolase (NSE), and Synaptophysin (Syn). According to the stage at diagnosis, patients were divided into three groups. Group (i) included patients who had organ confined disease, group (ii) included patients with locally invasive disease, and group (iii) with distant metastasis. NE expression was correlated with Gleason sum and clinical stage at presentation and analyzed using Chi-Square test and one way ANNOVA.
The mean age of the patients was 70 +/- 9.2 years. Group I had 14 patients, group II had 31 patients and group III had 39 patients. CgA was detected in 33 cases, Syn in 8 cases, and NSE in 44 cases. Expression of CgA was seen in 7% of group I, 37% in group II and 35% of group III patients (p 0.059). CgA (p 0.024) and NSE (p 0.006) had a significantly higher expression with worsening Gleason grade.
CgA has a better correlation with disease at presentation than other markers used. Both NSE and CgA had increasing expression with worsening histological grade this correlation has a potential for use as a prognostic indicator. Limitations in the current work included small number and retrospective nature of work. The findings of this work needs validation in a larger cohort.
前列腺腺癌中神经内分泌分化的免疫组织学检测对于疾病初诊时的病情及Gleason分级的重要性正逐渐得到认可。关于神经内分泌分化的三种常用标志物，即嗜铬粒蛋白A（CgA）、神经元特异性烯醇化酶（NSE）和突触素（Syn）的相对意义，相关文献有限。在当前研究中，我们评估了前列腺腺癌中神经内分泌分化的免疫组织学检测与疾病初诊时的病情及Gleason分级的相关性，并确定了各种标志物的相对价值。
对1991年1月至1998年12月期间84例患者的前列腺恶性标本（经尿道前列腺切除术或耻骨后根治性前列腺切除术）连续样本，使用选定的神经内分泌肿瘤标志物，即嗜铬粒蛋白A（CgA）、神经元特异性烯醇化酶（NSE）和突触素（Syn），通过免疫组织化学染色（PAP技术）进行评估。根据诊断时的分期，将患者分为三组。第一组（i）包括疾病局限于器官内的患者，第二组（ii）包括局部浸润性疾病患者，第三组（iii）包括远处转移患者。神经内分泌（NE）表达与初诊时的Gleason评分和临床分期相关，并使用卡方检验和单因素方差分析进行分析。
患者的平均年龄为70±9.2岁。第一组有14例患者，第二组有31例患者，第三组有39例患者。检测到33例CgA阳性，8例Syn阳性，44例NSE阳性。第一组7%的患者、第二组37%的患者和第三组35%的患者检测到CgA表达（p = 0.059）。随着Gleason分级恶化，CgA（p = 0.024）和NSE（p = 0.006）的表达显著更高。
与其他所用标志物相比，CgA与疾病初诊时的病情具有更好的相关性。随着组织学分级恶化，NSE和CgA的表达均增加，这种相关性有作为预后指标的潜力。当前研究的局限性包括样本数量少及研究的回顾性性质。本研究结果需要在更大队列中进行验证。
