Bubendorf L, Tapia C, Gasser T C, Casella R, Grunder B, Moch H, Mihatsch M J, Sauter G
Institute for Pathology and Urologic Clinics, University of Basel, Switzerland.
Hum Pathol. 1998 Sep;29(9):949-54. doi: 10.1016/s0046-8177(98)90199-x.
A better knowledge of the biological aggressiveness of individual tumors could facilitate the selection of treatment in prostate cancer patients. This study assesses the influence of histological and molecular features in core needle biopsy specimens of prostate cancer on tumor-specific survival. Formalin-fixed core needle biopsy specimens from 111 consecutive patients (mean follow-up, 5.0 years) were immunohistochemically examined for their proliferative activity (Ki67 labeling index [LI]) and expression of p53 and Bcl-2. Overexpression of p53 was found in 16% of the biopsy specimens and was mainly restricted to poorly differentiated tumors. Bcl-2 positivity was found in 20% of tumors. The median Ki67 LI was 7.5%. There was a strong relationship between Ki67 LI and Gleason grade, with a continuous increase in the proliferative activity from low-grade to high-grade tumors (P = .0006). Univariate tumor-specific survival analysis showed that high Gleason score (P = .0018), high percentage of biopsy tumor involvement (P = .0227), high Ki67 LI (P = .0007), and p53 positivity (P = .0024) were predictors of tumor-related death. A high Ki67 LI emerged as the only independent predictor of tumor-specific survival in multiparametric analysis. These results indicate that core needle biopsy specimens of the prostate not only are useful for diagnosis of malignancy but also can provide valuable prognostic information. Immunohistochemical examinations of molecular features may be a helpful adjunct for a better pretherapeutic assessment of prostate cancer aggressiveness and therefore contribute to an improved initial patient management.
对个体肿瘤生物学侵袭性有更深入的了解有助于前列腺癌患者治疗方案的选择。本研究评估前列腺癌粗针穿刺活检标本的组织学和分子特征对肿瘤特异性生存的影响。对111例连续患者（平均随访5.0年）的福尔马林固定粗针穿刺活检标本进行免疫组织化学检查，检测其增殖活性（Ki67标记指数[LI]）以及p53和Bcl-2的表达。在16%的活检标本中发现p53过表达，且主要局限于低分化肿瘤。20%的肿瘤中发现Bcl-2阳性。Ki67 LI的中位数为7.5%。Ki67 LI与Gleason分级之间存在密切关系，从低级别肿瘤到高级别肿瘤增殖活性持续增加（P = .0006）。单因素肿瘤特异性生存分析显示，高Gleason评分（P = .0018）、活检肿瘤累及的高百分比（P = .0227）、高Ki67 LI（P = .0007）和p53阳性（P = .0024）是肿瘤相关死亡的预测因素。在多参数分析中，高Ki67 LI是肿瘤特异性生存的唯一独立预测因素。这些结果表明，前列腺粗针穿刺活检标本不仅有助于恶性肿瘤的诊断，还能提供有价值的预后信息。分子特征的免疫组织化学检查可能是更好地进行前列腺癌侵袭性治疗前评估的有益辅助手段，因此有助于改善患者的初始管理。
