Independent prognostic role of circulating chromogranin A in prostate cancer patients with hormone-refractory disease
Independent prognostic role of circulating chromogranin A in prostate cancer patients with hormone-refractory disease
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DOI：
10.1677/erc.1.00876
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发表时间：
2005-03-01
影响因子：
3.9
通讯作者：
Dogliotti, L
中科院分区：
文献类型：
--
作者：
Berruti, A;Mosca, A;Dogliotti, L
神经内分泌（NE）分化的存在下，主要是外分泌前列腺癌可能发挥了关键作用，雄激素非依赖性肿瘤的生长。在一系列连续的前列腺癌患者中评估血浆嗜铬粒蛋白A（CgA）的预后意义。108例新诊断的前列腺癌患者进入研究。在基线（即发生激素不应性时）测量血浆CgA水平和其他生化参数，如血清前列腺特异性抗原、血清碱性磷酸酶、血清乳酸脱氢酶、血清白蛋白和血红蛋白浓度，并与患者体能状态、Gleason评分（诊断前列腺癌时）和内脏转移的存在一起评价其预后作用。此外，在50例接受化疗的患者中前瞻性地评估了血浆CgA，在基线时，45例（43.3%）患者显示CgA值升高。单因素分析（P = 0.008）和多因素分析（P < 0.05）表明，血浆CgA水平与生存率呈负相关。在接受化疗的患者亚组中，基线时的中位CgA（范围）值为13.3（3.0-141.0）U/l，3个月后为19.1（3.0-486.0）U/l，6个月后为20.8（3.0-702.0）U/l，9个月后为39.4（3.0-414.0）U/l（P < 0.01）。CgA水平升高与前列腺癌患者的预后密切相关，其超常率分别为17/50（34%）、23/50（46%）、26/50（52%）和34/50（68%）（P < 0.005）。激素难治性患者的NE分化是一种时间依赖性现象，不受常规化疗的影响。
The presence of neuroendocrine (NE) differentiation in the context of predominantly exocrine prostate cancer may play a key role in androgen-independent tumor growth. The prognostic significance of plasma chromogranin A (CgA) was assessed in a series of consecutive prostate cancer patients with hormone-refractory disease.One hundred and eight patients with newly diagnosed hormone-refractory prostate cancer entered the study. Plasma CgA levels and other biochemical parameters, such as serum prostate specific antigen, serum alkaline phosphatase, serum lactate dehydrogenase, serum albumin and hemoglobin concentration, were measured at baseline (i.e. when hormone refractoriness occurred) and their prognostic role was evaluated together with patient performance status, Gleason score (at diagnosis of prostate cancer) and the presence of visceral metastases. Furthermore, plasma CgA was prospectively evaluated in 50 patients undergoing chemotherapy.At baseline, 45 patients (43.3%) showed elevated CgA values. Plasma CgA negatively correlated with survival, either in univariate analysis (P = 0.008) or in multivariate analysis, after adjusting for previously mentioned prognostic parameters (P < 0.05). In the patient subset undergoing chemotherapy, median CgA (range) values were 13.3 (3.0-141.0) U/l at baseline, 19.1 (3.0-486.0) U/l after 3 months, 20.8 (3.0-702.0) U/l after 6 months and 39.4 (3.0-414.0) U/l after 9 months (P < 0.01). The corresponding supranormal rates were 17/50 (34%), 23/50 (46%), 26/50 (52%) and 34/50 (68%) respectively (P < 0.005).Elevated plasma CgA levels are frequently observed in prostate cancer patients with hormone-refractory disease and correlate with poor prognosis. NE differentiation in hormone- refractory patients is a time-dependent phenomenon and is not influenced by conventional antineoplastic treatments.