Murray Nigel P, Reyes Eduardo, Orellana Nelson, Fuentealba Cynthia, Orellana Sebastian, Jacob Omar
Hospital Carabineros of Chile, Nunoa,Chile Email :
Asian Pac J Cancer Prev. 2016;17(7):3089-93.
To determine the utility of primary circulating prostate cells (CPC) for predicting early biochemical failure after radical prostatectomy for prostate cancer and compare the results with the Walz nomogram.
A single centre prospective study of men with prostate cancer treated with radical prostatectomy was conducted between 2004 and 2014. Clinicalpathological details were registered, along with total serum PSA presurgery, Gleason score, extracapsular extension, positive surgical margins, infiltration of lymph nodes, seminal vesicles and pathological stage. Primary circulating prostate cells were obtained using differential gel centrifugation and detected using standard immunocytochemistry with antiPSA. Biochemical failure was defined as a PSA >0.2ng/ml, predictive values were calculated using the Walz nomagram and CPC detection.
A total of 285 men participated, of whom 103/285 (36.1%) suffered biochemcial failure; 32/103 (31.1%) within two years of radical prostatectomy. Men with higher Gleason scores, higher pathological stage, infiltration of the surgical margin or prostate capsule and infiltration of seminal vesicles were more likely to undergo biochemical failure. There was a significant increase in the frequency of biochemical failure with increasing number of CPCs detected (p<0.0004 Chi squared for trend) and increasing percent prediction for the Walz nomogram (p<0.0001 Chi squared for trends). The positive predictive value of primary CPC detection, even using a cutoff point of ≥ 4 cells/sample was very low.
The detection of primary CPCs in men as a prognostic factor pretreatment fails to identify those at high risk of biochemical failure within two years of curative therapy. This is in keeping with their biological significance, that the majority of them will be eliminated by the primary therapy and thus have no influence on the subsequent clinical history of the patient.
确定原发性循环前列腺细胞（CPC）在预测前列腺癌根治术后早期生化复发方面的效用，并将结果与瓦尔兹列线图进行比较。
2004年至2014年间，对接受前列腺癌根治术的男性进行了一项单中心前瞻性研究。记录临床病理细节，包括术前总血清前列腺特异性抗原（PSA）、 Gleason评分、包膜外侵犯、手术切缘阳性、淋巴结浸润、精囊浸润和病理分期。采用差异凝胶离心法获取原发性循环前列腺细胞，并使用抗PSA标准免疫细胞化学法进行检测。生化复发定义为PSA>0.2ng/ml，使用瓦尔兹列线图和CPC检测计算预测值。
共有285名男性参与，其中103/285（36.1%）发生生化复发；32/103（31.1%）在前列腺癌根治术后两年内复发。Gleason评分较高、病理分期较高、手术切缘或前列腺包膜浸润以及精囊浸润的男性更易发生生化复发。随着检测到的CPC数量增加，生化复发频率显著增加（趋势检验卡方值p<0.0004），瓦尔兹列线图的预测百分比增加（趋势检验卡方值p<0.0001）。即使采用≥4个细胞/样本的截断点，原发性CPC检测的阳性预测值也非常低。
将男性原发性CPC检测作为预后因素进行预处理，无法识别那些在根治性治疗后两年内有高生化复发风险的患者。这与它们的生物学意义相符，即它们中的大多数会被原发性治疗清除，因此对患者随后的临床病程没有影响。
