Carneiro Arie, Barbosa Álan Roger Gomes, Takemura Lucas Seiti, Kayano Paulo Priante, Moran Natasha Kouvaleski Saviano, Chen Carolina Ko, Wroclawski Marcelo Langer, Lemos Gustavo Caserta, da Cunha Isabela Werneck, Obara Marcos Takeo, Tobias-Machado Marcos, Sowalsky Adam G, Bianco Bianca
Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Front Oncol. 2018 Sep 18;8:377. doi: 10.3389/fonc.2018.00377. eCollection 2018.
Prostate cancer (PCa) is a heterogeneous disease that lends itself toward numerous therapeutic options depending on its risk stratification. One of the greatest challenges in PCa urologic practice is to select patients who should be referred for biopsy and, for those patients who are diagnosed with cancer, to differentiate between patients with indolent disease from those with an unfavorable prognosis and, to determine ideal patient management and avoid unnecessary interventions. Accordingly, there is a growing body of literature reporting immunohistochemical studies with the objective of determining a prostate cancer prognosis. Among the most frequent biomarkers studied are Ki-67, p53, PTEN, MYC, and ERG. Based on these findings, we systematically reviewed articles that assessed the role of these main prognostic markers in prostate cancer. Consistent with PRISMA guidelines, we performed a systematic literature search throughout the Web of Science and PubMed Medline databases. We considered all types of studies evaluating the role of Ki-67, p53, PTEN, MYC, and ERG immunohistochemical analysis in prostate cancer until July 2017. We identified 361 articles, 44 of which were summarized in this review. Diagnostically, no single immunohistochemical marker was able to define a tumor as benign or malignant. Prognostically, Ki-67, p53, and MYC were related to the tumor grade given by Gleason score and to the tumor stage (higher levels related to higher tumor grade). Furthermore, Ki-67 was also related to higher PSA levels, shorter disease-free intervals and shorter tumor-specific survival; the latter was also related to p53. The loss of PTEN protein expression showed a higher association with biochemical recurrence and with a worse prognosis, beyond that predicted by the Gleason score and tumor stage. ERG staining also showed a strong association with biochemical recurrence. There are several studies relating immunohistochemical markers with clinical-laboratorial outcomes in prostate cancer, the most frequent being Ki-67, p53, ERG, PTEN, and MYC. However, none of these markers have been validated by literary consensus to be routinely applied in medical practice.
前列腺癌(PCa)是一种异质性疾病,根据其风险分层有多种治疗选择。前列腺癌泌尿外科实践中最大的挑战之一是选择应接受活检的患者,对于那些被诊断为癌症的患者,要区分惰性疾病患者和预后不良的患者,并确定理想的患者管理方案,避免不必要的干预。因此,越来越多的文献报道了旨在确定前列腺癌预后的免疫组化研究。研究最频繁的生物标志物包括Ki-67、p53、PTEN、MYC和ERG。基于这些发现,我们系统地回顾了评估这些主要预后标志物在前列腺癌中作用的文章。按照PRISMA指南,我们在科学网和PubMed Medline数据库中进行了系统的文献检索。我们纳入了所有评估Ki-67、p53、PTEN、MYC和ERG免疫组化分析在前列腺癌中作用的研究类型,检索截至2017年7月。我们共识别出361篇文章,本综述总结了其中的44篇。在诊断方面,没有单一的免疫组化标志物能够将肿瘤定义为良性或恶性。在预后方面,Ki-67、p53和MYC与Gleason评分给出的肿瘤分级以及肿瘤分期相关(水平越高,肿瘤分级越高)。此外,Ki-67还与较高的PSA水平、较短的无病间期和较短的肿瘤特异性生存期相关;后者也与p53相关。PTEN蛋白表达的缺失与生化复发及更差的预后有更高的相关性,超出了Gleason评分和肿瘤分期所预测的范围。ERG染色也与生化复发有很强的相关性。有几项研究将免疫组化标志物与前列腺癌的临床实验室结果相关联,最常见的是Ki-67、p53、ERG、PTEN和MYC。然而,这些标志物均未通过文献共识验证可常规应用于医学实践。