PSMA expression: a potential ally for the pathologist in prostate cancer diagnosis.
PSMA expression: a potential ally for the pathologist in prostate cancer diagnosis.
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DOI：
10.1038/s41598-018-22594-1
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发表时间：
2018-03-09
影响因子：
4.6
通讯作者：
Paganelli G
中科院分区：
文献类型：
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作者：
Bravaccini S;Puccetti M;Bocchini M;Ravaioli S;Celli M;Scarpi E;De Giorgi U;Tumedei MM;Raulli G;Cardinale L;Paganelli G
前列腺癌（PCa）患者基于诊断时的临床分期和PSA水平以及前列腺活检中的Gleason评分（GS）进行风险分层。然而，这些参数在区分高风险和低风险疾病方面并不完全准确，因此需要一种可靠的标记物来确定侵袭性。前列腺特异性膜抗原（PSMA）似乎可以满足这一需求。我们分析了79例前列腺活检和28例前列腺切除术，以评估通过免疫组织化学检测的PSMA表达是否与GS相关。PSMA表达与两种样本类型中的GS相关（活检，P < 0.0001和直肠切除术样本，P = 0.007）。我们观察到Gleason模式3中的PSMA表达低于Gleason模式4，表明该生物标志物可用于区分这些实体（p < 0.0001）。通过受试者工作特征（ROC）曲线分析确定45%免疫阳性的最佳临界值。在Gleason模式3与Gleason模式4和5中，PSMA敏感性为84.1%（95% CI 76.5%-91.7%），特异性为95.2%（95% CI 90.6%-99.8%），曲线下面积为93.1（95% CI 88.8-97.4）。我们的研究结果表明，PSMA是病理学家在诊断PCa时克服长期存在的形态学分类限制的潜在盟友。
Prostate cancer (PCa) patients are risk-stratified on the basis of clinical stage and PSA level at diagnosis and the Gleason Score (GS) in prostate biopsy. However, these parameters are not completely accurate in discriminating between high- and low-risk disease, creating a need for a reliable marker to determine aggressiveness. Prostate-specific membrane antigen (PSMA) appears to fulfill this need. We analyzed 79 prostate biopsies and 28 prostatectomies to assess whether PSMA expression detected by immunohistochemistry is related to GS. PSMA expression was correlated with GS in both sample types (biopsies, P < 0.0001 and prostatectomy samples, P = 0.007). We observed lower PSMA expression in Gleason pattern 3 than Gleason pattern 4, suggesting that this biomarker could be useful to distinguish between these entities (p < 0.0001). The best cut-off value of 45% immunopositivity was determined by receiver operating characteristic (ROC) curve analysis. In Gleason pattern 3 vs. Gleason pattern 4 and 5, PSMA sensitivity was 84.1% (95% CI 76.5%-91.7%) and specificity was 95.2% (95% CI 90.6%-99.8%), with an area under the curve of 93.1 (95% CI 88.8–97.4). Our results suggest that PSMA represents a potential ally for the pathologist in the diagnostic work-up of PCa to overcome long-standing morphological classification limits.