Partin A W, Criley S R, Steiner M S, Hsieh K, Simons J W, Lumadue J, Carter H B, Marshall F F
Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Urology. 1995 Feb;45(2):211-7. doi: 10.1016/0090-4295(95)80007-7.
At present, 35% to 50% of patients with clinically localized renal cell carcinoma (RCC) unpredictably have a recurrence after surgical therapy. Presently, no clinical serum marker exists to detect occult metastases and to allow measurement of response to therapy in RCC. Serum ferritin was previously reported to correlate with pathologic stage. We postulated that this increase in serum ferritin with increasing stage might reflect tumor volume, since higher stage tumors are often larger.
Serum ferritin levels were measured preoperatively in 30 patients with radiologic evidence of RCC. Tumor volume and the largest tumor dimension were calculated from either the pathologic specimen (n = 24) or from the computed tomography or magnetic resonance imaging (n = 30). Pathologic stage was determined for all patients undergoing surgery (T1 = 3, T2 = 12, and T3 = 9).
Preoperative serum ferritin levels did not correlate with age, blood urea nitrogen levels, creatinine levels, hematocrit, race, or gender. Although mean serum ferritin levels increased with increasing stage (T1 = 113 +/- 75, T2 = 254 +/- 270, and T3 = 425 +/- 257 ng/mL), these differences did not reach statistical significance (P > 0.05). Serum ferritin did, however, correlate with tumor volume (R = 0.75; P < 0.0001) and the largest tumor dimension measured from radiographic studies (R = 0.8; P < 0.0001). Serum ferritin measured intraoperatively from the renal vein (666 ng/mL) and the inferior vena cava (564 ng/mL) from a patient with a 500 cc tumor (preoperative serum ferritin, 552 ng/mL) suggested that the tumor was the source of the elevated ferritin levels. Histologic sections from tumors taken from patients with high serum ferritin levels were more necrotic and stained intensely positively for iron and immunohistochemically for ferritin, whereas adjacent histologically normal tissue did not.
These data suggest that ferritin may be a useful serum marker for monitoring patients with RCC, but the actual source of the ferritin remains unclear and dictates further investigation.
目前，35%至50%临床局限性肾细胞癌（RCC）患者在手术治疗后会出现不可预测的复发。目前，尚无临床血清标志物可用于检测隐匿性转移并评估RCC患者对治疗的反应。先前有报道称血清铁蛋白与病理分期相关。我们推测血清铁蛋白随分期增加而升高可能反映肿瘤体积，因为更高分期的肿瘤通常更大。
对30例有RCC影像学证据的患者术前测定血清铁蛋白水平。肿瘤体积和最大肿瘤直径根据病理标本（n = 24）或计算机断层扫描或磁共振成像（n = 30）计算得出。对所有接受手术的患者确定病理分期（T1 = 3例，T2 = 12例，T3 = 9例）。
术前血清铁蛋白水平与年龄、血尿素氮水平、肌酐水平、血细胞比容、种族或性别无关。虽然血清铁蛋白平均水平随分期增加而升高（T1 = 113±75，T2 = 254±270，T3 = 425±257 ng/mL），但这些差异无统计学意义（P > 0.05）。然而，血清铁蛋白与肿瘤体积（R = 0.75；P < 0.0001）以及影像学研究测得的最大肿瘤直径（R = 0.8；P < 0.0001）相关。一名肿瘤体积为500 cc的患者（术前血清铁蛋白为552 ng/mL）术中测得肾静脉血清铁蛋白为666 ng/mL，下腔静脉血清铁蛋白为564 ng/mL，提示肿瘤是铁蛋白水平升高的来源。血清铁蛋白水平高的患者肿瘤组织学切片坏死更严重，铁染色和铁蛋白免疫组化染色呈强阳性，而相邻的组织学正常组织则无此现象。
这些数据表明铁蛋白可能是监测RCC患者的有用血清标志物，但铁蛋白的实际来源仍不清楚，需要进一步研究。
