Kodama Yoshiki, Kondo Tsunenori, Matsumura Nagahide, Shimokawa Toshio, Kohjimoto Yasuo, Tanabe Kazunari, Hara Isao
Department of Urology, Wakayama Medical University, Wakayama, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Int J Urol. 2017 Nov;24(11):799-806. doi: 10.1111/iju.13429. Epub 2017 Oct 12.
To determine the significance of molecular diagnosis of lymph node metastasis using quantitative reverse transcription polymerase chain reaction in patients with upper urinary tract urothelial cancer.
A total of 51 patients with upper urinary tract urothelial cancer who underwent extended lymphadenectomy were included in the present study. Retrieved lymph nodes from each patient were divided into two parts. One part was assessed by quantitative reverse transcription polymerase chain reaction assay for molecular staging, whereas the other one was assessed by routine histopathological examination. Four kinds of molecules (FXYD3, KRT19, KRT20 and UPK2) were selected as markers to detect urothelial cancer cells.
The average number of retrieved lymph nodes was 18.3. As UPK2 showed the best discrimination ability among four markers, the patients were classified in three categories according to UPK2 expression: N(+)PCR(+) for patients who had lymph node metastasis by routine pathological diagnosis as well as quantitative reverse transcription polymerase chain reaction (n = 4); N(-)PCR(+) for patients who had lymph node metastasis by polymerase chain reaction but not by routine pathological diagnosis (n = 7); and N(-)PCR(-) for patients who showed no lymph node metastasis not only by routine pathological diagnosis but also by polymerase chain reaction (n = 40). The prognosis of the N(-)PCR(+) group was better than that of the N(+)PCR(+) group, and similar to that of the N(-)PCR(-) group.
Quantitative reverse transcription polymerase chain reaction could detect micrometastasis in patients with upper urinary tract urothelial cancer. However, the prognosis of patients with micrometastasis is better than patients with pathologically metastasized lymph nodes, and similar to patients without micrometastasis.
确定定量逆转录聚合酶链反应在检测上尿路尿路上皮癌患者淋巴结转移分子诊断中的意义。
本研究纳入51例行扩大淋巴结清扫术的上尿路尿路上皮癌患者。从每位患者获取的淋巴结分为两部分。一部分通过定量逆转录聚合酶链反应分析进行分子分期评估，另一部分通过常规组织病理学检查进行评估。选择四种分子（FXYD3、KRT19、KRT20和UPK2）作为检测尿路上皮癌细胞的标志物。
获取的淋巴结平均数量为18.3个。由于UPK2在四种标志物中显示出最佳的鉴别能力，根据UPK2表达将患者分为三类：N(+)PCR(+)组为常规病理诊断及定量逆转录聚合酶链反应均显示有淋巴结转移的患者（n = 4）；N(-)PCR(+)组为聚合酶链反应显示有淋巴结转移但常规病理诊断未显示的患者（n = 7）；N(-)PCR(-)组为常规病理诊断及聚合酶链反应均未显示有淋巴结转移的患者（n = 40）。N(-)PCR(+)组的预后优于N(+)PCR(+)组，与N(-)PCR(-)组相似。
定量逆转录聚合酶链反应可检测上尿路尿路上皮癌患者的微转移。然而，微转移患者的预后优于有病理转移淋巴结的患者，与无微转移患者相似。
