Xia Wei-mu, Liu Ding-yi, Zhou Wen-long, Wang Ming-wei, Wang Jian, Wang Ying, Wang Shu-jun, Xu Yu-sheng, Ye Yong-feng, Zhang Li
Department of Urology, 184th Hospital of Public Liberation Army, Yingtan 335000, China.
Zhonghua Wai Ke Za Zhi. 2010 Oct 15;48(20):1565-8.
To clarify the significance of micrometastases in pelvic lymph nodes in patients with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP).
Twenty-one patients with clinically localized prostate cancer who received NHT between August 2007 and March 2010 were observed. The patients were clarified into four groups: pathological examination was positive (group A), real-time PCR examination targeting prostate specific antigen (PSA) mRNA and prostate specific membrane antigen (PSMA) mRNA were positive (group B), pathological examination and real-time PCR examination targeting PSA mRNA and PSMA mRNA were both negative (group C), and the control group (group D). After a standard bipedal lymphangiography the films were reviewed carefully by an experienced radiologist. If positive lymph nodes were seen or suspected, a thin-walled 22 gauge needle were directed transabdominally under fluoroscopic control into the area of question and an aspirate was obtained. The expression of PSA and PSMA in aspirate were assessed by a fully quantitative real-time PCR. The specimens were regarded in which either PSA mRNA or PSMA mRNA were positive as showing the "presence of micrometastasis". Lymph node specimens were also stained immunohistochemically with an antibody PSA after RP.
Pathological examination detected lymph node metastases from 3 cases, and real-time PCR further identified lymph node micrometastases from 14 cases with no pathological evidence of nodal involvement. The expression level of PSA mRNA and PSMA mRNA were statistically significant in patients with histological confirmed lymph node metastases and micrometastases detected by real-time PCR despite the lack of histological evidence, and the expression level of PSA mRNA and PSMA mRNA in aspirate were higher than the lymph node between the group A and group B.
Although residual foci of atrophic prostate cancer cells in resected lymph nodes after NHT can be difficult to diagnose by pathological examination, the present results show the usefulness of quantitative real-time PCR targeting PSA and PSMA mRNA for detected micrometastatic tumour foci in pelvic lymph nodes from fine needle aspiration biopsy of lymph nodes before RP.
阐明新辅助激素治疗（NHT）后行根治性前列腺切除术（RP）的患者盆腔淋巴结微转移的意义。
观察2007年8月至2010年3月期间接受NHT的21例临床局限性前列腺癌患者。将患者分为四组：病理检查阳性（A组）、针对前列腺特异性抗原（PSA）mRNA和前列腺特异性膜抗原（PSMA）mRNA的实时PCR检查阳性（B组）、病理检查及针对PSA mRNA和PSMA mRNA的实时PCR检查均为阴性（C组）以及对照组（D组）。在进行标准的双侧淋巴管造影后，由经验丰富的放射科医生仔细复查造影片。若发现或怀疑有阳性淋巴结，则在荧光透视引导下经腹部将22号薄壁针插入可疑区域获取抽吸物。通过全定量实时PCR评估抽吸物中PSA和PSMA的表达。将PSA mRNA或PSMA mRNA阳性的标本视为显示“存在微转移”。RP术后，淋巴结标本也用抗PSA抗体进行免疫组织化学染色。
病理检查检测到3例淋巴结转移，实时PCR进一步鉴定出14例无淋巴结受累病理证据的淋巴结微转移。尽管缺乏组织学证据，但组织学证实有淋巴结转移及实时PCR检测到微转移的患者中，PSA mRNA和PSMA mRNA的表达水平具有统计学意义，且A组和B组抽吸物中PSA mRNA和PSMA mRNA的表达水平高于淋巴结中的表达水平。
尽管NHT后切除的淋巴结中萎缩的前列腺癌细胞残留灶通过病理检查难以诊断，但目前结果表明，在RP前对淋巴结进行细针穿刺活检时，针对PSA和PSMA mRNA的定量实时PCR对于检测盆腔淋巴结中的微转移肿瘤灶是有用的。
