前列腺干细胞抗原mRNA在术前活检阴性标本中的表达可预测经尿道前列腺电切术治疗良性前列腺增生后是否会发生后续癌症。

Prostate stem cell antigen mRNA expression in preoperatively negative biopsy specimens predicts subsequent cancer after transurethral resection of the prostate for benign prostatic hyperplasia.

作者信息

Zhao Zhigang, Liu Jieming, Li Su, Shen Wenlu

机构信息

Department of Urology, The Second Affiliated Hospital, Shantou University Medical College, Guangdong Province, China.

出版信息

Prostate. 2009 Sep 1;69(12):1292-302. doi: 10.1002/pros.20973.

DOI:10.1002/pros.20973

PMID:19462463

Abstract

BACKGROUND

Recent data showed that prostate stem cell antigen (PSCA) mRNA expression in transurethral resection of the prostate (TURP)-resected tissues predicted the subsequent prostate cancer after TURP in benign prostatic hyperplasia (BPH) patients with both PSA < 4.0 ng/ml and normal DRE findings. This study was to determine whether PSCA mRNA positivity in preoperatively negative prostatic biopsy samples from BPH men with PSA > 4.0 ng/ml and/or suspicious DRE findings had predictive performance following TURP.

MATERIALS AND METHODS

PSCA in situ hybridization was performed on negative prostatic biopsies taken before TURP from 166 enrolled symptomatic BPH patients, who were continuously followed for 5 years postoperatively. Predictive performance of PSCA mRNA for subsequent cancer onset was evaluated by univariate and multivariate Cox proportional hazards models with bootstrapping and concordance indices.

RESULTS

PSCA mRNA was detected in 42/166 (25.3%) of the preoperatively negative biopsy specimens, with a mean positive-labeling cells of 31.6%, in which 31 patients were identified as having subsequent PCa on follow-up. Of 124 patients with negative expression for PSCA mRNA none were subsequently diagnosed with PCa. The examination of Spearman's rank correlation coefficient showed that PSCA mRNA expression levels were positively and statistically correlated with higher Gleason score (r = 0.88, P < 0.001) and clinical T stage (r = 0.84, P < 0.001). A final multivariate Cox proportional hazards model demonstrated that only PSCA mRNA expression in negative prostatic biopsies was predictive of the subsequent cancer development after TURP (hazard ratio = 3.49; 95% CI: 2.02-4.75; P < 0.001), with the concordance index of 0.893.

CONCLUSIONS

This prospective study identifies PSCA mRNA in preoperatively negative prostatic biopsies as a significant predictor of subsequent cancer after TURP.

摘要

背景

近期数据显示，在前列腺特异性抗原（PSA）<4.0 ng/ml且直肠指检（DRE）结果正常的良性前列腺增生（BPH）患者中，经尿道前列腺切除术（TURP）切除组织中的前列腺干细胞抗原（PSCA）mRNA表达可预测TURP术后的前列腺癌。本研究旨在确定PSA>4.0 ng/ml和/或DRE结果可疑的BPH男性术前前列腺活检样本中PSCA mRNA阳性是否具有TURP术后的预测性能。

材料与方法

对166例有症状的入选BPH患者在TURP术前进行的阴性前列腺活检标本进行PSCA原位杂交，并在术后持续随访5年。通过单变量和多变量Cox比例风险模型以及自抽样和一致性指数评估PSCA mRNA对后续癌症发生的预测性能。

结果

在166例术前阴性活检标本中的42例（25.3%）检测到PSCA mRNA，平均阳性标记细胞为31.6%，其中31例患者在随访中被确定患有后续前列腺癌（PCa）。在124例PSCA mRNA表达阴性的患者中，无一例随后被诊断为PCa。Spearman等级相关系数检验显示，PSCA mRNA表达水平与较高的Gleason评分（r = 0.88，P < 0.001）和临床T分期（r = 0.84，P < 0.001）呈正相关且具有统计学意义。最终的多变量Cox比例风险模型表明，只有阴性前列腺活检中的PSCA mRNA表达可预测TURP术后的后续癌症发展（风险比 = 3.49；95% CI：2.02 - 4.75；P < 0.001），一致性指数为0.893。