van den Ouden D, Tribukait B, Blom J H, Fossa S D, Kurth K H, ten Kate F J, Heiden T, Wang N, Schroder F H
Department of Urology and Nephrology, Erasmus University, Rotterdam, The Netherlands.
J Urol. 1993 Aug;150(2 Pt 1):400-6. doi: 10.1016/s0022-5347(17)35493-9.
We studied 98 patients with locally confined but lymph node positive prostatic cancer (1 stage T1, 29 stage T2, 55 stage T3 and 2 stage T4) who were not treated by radical prostatectomy. A retrospective analysis was done of deoxyribonucleic acid (DNA) ploidy of pretreatment core biopsies of the primary tumor and lymph node metastases. While DNA ploidy has been shown to be an important prognostic factor if applied to radical prostatectomy specimens, core biopsy specimens and nodal metastases have rarely been studied. Of the 98 patients 87 were evaluable for DNA ploidy: 45 (52%) had diploid, 13 (15%) had tetraploid and 29 (33%) had aneuploid tumors. The ploidy of the primary tumor and of the lymph node metastases correlated significantly with the rate of progression and interval to progression. Also, significant correlations were noted between the percentages of cells in the S phase or S plus G2 phases of the cell cycle and interval to progression. Most patients in this study are part of the European Organization for Research and Treatment of Cancer protocol 30846, a prospective randomized study of early versus delayed treatment in lymph node positive, otherwise locally confined prostate cancer. This study is ongoing. Early endocrine treatment was associated with a significantly longer interval to progression. In a Cox regression analysis of the prognostic factors involved in this study, early endocrine treatment was more important than ploidy or proliferation patterns. Stage (T category) and histopathological grade did not show a correlation with progression. Followup is still too short and the numbers of patients are too small for relevant subgroup analysis. DNA ploidy measurement by flow cytometry on archival (paraffin embedded) core biopsy and lymph node material is possible, and produces meaningful results in predicting the prognosis of prostatic cancer. Since this information can be made available before treatment decisions, its exact value in the management of locally confined prostate cancer can be determined.
我们研究了98例局部局限但淋巴结阳性的前列腺癌患者（1例T1期、29例T2期、55例T3期和2例T4期），这些患者未接受根治性前列腺切除术。对原发性肿瘤和淋巴结转移灶的预处理芯针活检组织进行了脱氧核糖核酸（DNA）倍体的回顾性分析。虽然DNA倍体已被证明应用于根治性前列腺切除术标本时是一个重要的预后因素，但芯针活检标本和淋巴结转移灶很少被研究。在这98例患者中，87例可进行DNA倍体评估：45例（52%）为二倍体，13例（15%）为四倍体，29例（33%）为非整倍体肿瘤。原发性肿瘤和淋巴结转移灶的倍体与进展率和进展间隔显著相关。此外，细胞周期S期或S加G2期的细胞百分比与进展间隔之间也存在显著相关性。本研究中的大多数患者是欧洲癌症研究与治疗组织方案30846的一部分，这是一项关于淋巴结阳性、其他方面局部局限的前列腺癌早期与延迟治疗的前瞻性随机研究。该研究正在进行中。早期内分泌治疗与显著更长的进展间隔相关。在对本研究中涉及的预后因素进行的Cox回归分析中，早期内分泌治疗比倍体或增殖模式更重要。分期（T类别）和组织病理学分级与进展无相关性。随访时间仍然太短，患者数量太少，无法进行相关的亚组分析。通过流式细胞术对存档（石蜡包埋）芯针活检组织和淋巴结材料进行DNA倍体测量是可行的，并且在预测前列腺癌预后方面能产生有意义的结果。由于在做出治疗决策之前就能获得这些信息，因此可以确定其在局部局限前列腺癌管理中的确切价值。
