摘要
目的明确新辅助治疗后前列腺癌根治术前，real—timePCR检测盆腔淋巴结微转移的意义。方法2007年8月至2010年3月对21例临床局限性前列腺癌病例，根据病理检查阳性（A组）、real—timePCR检查前列腺特异性抗原（PSA）mRNA和前列腺特异性膜抗原（PSMA）mRNA阳性（B组）、病理检查及real—timePCR检查PSA mRNA及PSMAmRNA均阴性（C组）进行分组，D组为对照组。术前行淋巴管造影显示盆腔淋巴结，对可疑淋巴结在x线定位下穿刺抽吸淋巴液，用real—timePCR方法检测淋巴液中PSAmRNA和PSMAmRNA的表达，阳性表达提示淋巴结转移的存在，术后对淋巴结组织切片进行免疫组化检查。结果对术前盆腔淋巴结穿刺抽吸淋巴液用real—timePCR方法检测PSAmRNA和PSMAmRNA的表达，证实有14例淋巴结存在微转移，术后对清扫淋巴结进行免疫组化检查有3例存在淋巴结转移，A组与B组PSA mRNA和PSMA mRNA的表达存在明显的差异；A、B组淋巴液中PSA mRNA及PSMA mRNA的表达明显高于淋巴结（P〈0．01）。结论采用real—timePCR方法检测淋巴液中PSA和PSMA mRNA的表达有利于探测到淋巴结微转移的存在，术前穿刺淋巴结抽吸淋巴液提高了术前前列腺癌分期的准确性。
Objective To clarify the significance of micrometastases in pelvic lymph nodes in patients with neoadjuvant hormonal therapy（NHT） before radical prostatectomy（RP）. Methods Twentyone patients with clinically localized prostate cancer who received NHT between August 2007 and March 2010 were observed. The patients were clarified into four groups： pathological examination was positive （group A）, real-time PCR examination targeting prostate specific antigen （PSA） mRNA and prostate specific membrane antigen （PSMA） mRN A were positive （group B） , pathological examination and real-time PCR examination targeting PSA mRNA and PSMA mRNA were both negative （ group C ） , and the control group（ group D ）. After a standard bipedal lymphangiography the films were reviewed carefully by an experienced radiologist, ff positive lymph nodes were seen or suspected, a thin-walled 22 gauge needle were directed transabdomenally under fluoroscopic control into the area of question and an aspirate was obtained. The expression of PSA and PSMA in aspirate were assessed by a fully quantitative real-time PCR. The specimens were regarded in which either PSA mRNA or PSMA mRNA were positive as showing the ＂presence of micrometastasis＂. Lymph node specimens were also stained immunohistochemically with an antibody PSA after RP. Results Pathological examination detected lymph node metastases from 3 cases, and real-time PCR further identified lymph node micrometastases from 14 cases with no pathological evidence of nodal involvement. The expression level of PSA mRNA and PSMA mRNA were statiscally significant in patients with histological confirmed lymph node metastases and micrometastases detected by real-time PCR despite the lack of histological evidence, and the expression level of PSA mRNA and PSMA mRNA in aspirate were higher than the lymph node between the group A and group B. Conclusions Although residual foci of atrophic prostate cancer ceils in resected lymph nodes after NHT can be difficult to diagnose by pathological examination, the present results show the usefulness of quantitative real-time PCR targeting PSA and PSMA mRNA for detected micrometastatic tumour loci in pelvic lymph nodes from fine needle aspiration biopsy of lymph nodes before RP.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2010年第20期1565-1568,共4页
Chinese Journal of Surgery
基金
南京军区医学科学技术研究“十一五”计划资助项目（07M058）
关键词
前列腺肿瘤
淋巴转移
微转移
实时定量聚合酶链反应
Prostate neoplasms
Lymphatic metastasis
Micrometastasis
Rreal-time reverse transcriptase polymerase chain reaction
