Moul J W, Connelly R R, Perahia B, McLeod D G
Department of Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.
J Urol. 1998 Mar;159(3):935-40.
We examine the clinical prognostic value of the currently available simple and inexpensive immunoenzymatic prostatic acid phosphatase (PAP) assay for the staging and prognosis of radical prostatectomy cases.
Between February 1, 1990 and May 3, 1996 pretreatment PAP was measured in 295 patients who underwent radical prostatectomy. From February 1, 1990 to May 17, 1992 the Hybritech Tandem-E assay was used in 75 cases, from May 18, 1992 to February 28, 1993 the Abbott EIA assay was used in 49 and from March 1, 1993 to May 3, 1996 the Abbott IMx assay was used in 171. PAP assays were analyzed individually and the results were combined with pretreatment prostate specific antigen (PSA) values to assess the ability to predict organ confined prostate cancer and serological recurrence after radical prostatectomy.
PAP testing was not of value for predicting organ confined disease or positive margins. However, this test was useful for predicting the first serological PSA recurrence in the 3 periods (77 to 85% correct) and overall (82% correct, p < 0.001, odds ratio 6.06). The Kaplan-Meier disease-free survival rate at 4 years was 78.8% for men with PAP less than 3 ng./ml. and 38.8% for those with PAP 3 ng./ml. or greater, which was significant when pretreatment PSA was less than 10 ng./ml. (p = 0.047), 10 ng./ml. or greater (p = 0.012) and overall (p < 0.001). PAP testing added prognostic information to pretreatment PSA values and it was an independent predictor of recurrence.
The widely available and inexpensive PAP assays of the 1990s are predictors of recurrence after radical prostatectomy. They should be included in future studies of prostate cancer recurrence modeling. However, they do not predict pathological stage or margin status.
我们研究当前可用的简单且廉价的免疫酶促前列腺酸性磷酸酶（PAP）检测对根治性前列腺切除术病例分期及预后的临床预后价值。
1990年2月1日至1996年5月3日期间，对295例行根治性前列腺切除术的患者进行了术前PAP检测。1990年2月1日至1992年5月17日，75例患者使用Hybritech Tandem-E检测法；1992年5月18日至1993年2月28日，49例患者使用雅培酶免疫分析检测法；1993年3月1日至1996年5月3日，171例患者使用雅培IMx检测法。对PAP检测结果进行单独分析，并将结果与术前前列腺特异性抗原（PSA）值相结合，以评估预测根治性前列腺切除术后器官局限性前列腺癌及血清学复发的能力。
PAP检测对预测器官局限性疾病或切缘阳性无价值。然而，该检测在三个时间段（正确率77%至85%）及总体（正确率82%，p<0.001，优势比6.06）对预测首次血清学PSA复发有用。PAP低于3 ng/ml的男性患者4年无病生存率为78.8%，PAP为3 ng/ml或更高的患者为38.8%，当术前PSA低于10 ng/ml（p=0.047）、10 ng/ml或更高（p=0.012）及总体（p<0.001）时，差异有统计学意义。PAP检测为术前PSA值增加了预后信息，且是复发的独立预测因子。
20世纪90年代广泛应用且价格低廉的PAP检测可预测根治性前列腺切除术后的复发情况。它们应纳入未来前列腺癌复发建模研究。然而，它们无法预测病理分期或切缘状态。
