The value of a reverse transcriptase polymerase chain reaction assay in preoperative staging and followup of patients with prostate cancer
The value of a reverse transcriptase polymerase chain reaction assay in preoperative staging and followup of patients with prostate cancer
复制标题
DOI：
10.1016/s0022-5347(01)63530-4
复制
发表时间：
1998-04-01
影响因子：
6.6
通讯作者：
Lange, PH
中科院分区：
文献类型：
--
作者：
Ellis, WJ;Vessella, RL;Lange, PH
目的：逆转录聚合酶链反应（RT-PCR）检测是一种检测前列腺特异性抗原（PSA）表达细胞的灵敏技术。关于外周血PSA RT-PCR检测反映病理分期或治疗结果的能力存在争议。我们研究了前列腺癌患者的RT-PCR结果的现象学，特别强调了根治性前列腺切除术前后的RT-PCR检测，以及与病理分期和治疗结果的相关性。材料与方法：收集了各种前列腺癌患者的外周血，包括根治性前列腺切除术前后的外周血。核糖核酸分离后，生成互补脱氧核糖核酸并用热启动技术扩增。RT-PCR结果与病理分期、Gleason评分、肿瘤体积及无病状态进行比较。术前和术后的RT-PCR检测也有相关性。结果：56例对照中有1例（1.8%）RT-PCR检测阳性，未怀疑前列腺癌。65名男性中有12名（18.5%）怀疑前列腺癌，但活检呈阴性。根治性前列腺切除术前，75例pT2患者中有13例（17.3%）检测阳性，而46例pT3患者中有10例（21.7%）检测阳性。血清PSA、Gleason评分和肿瘤体积在阳性和阴性男性之间无显著差异。随着重复检测，男性术前至少有一次阳性检测的比例越来越高。在中位8个月的随访中，7例根治性前列腺切除术失败的患者中有6例在治疗前的RT-PCR阴性。在已知转移性疾病或初次治疗失败的患者中，32%至75%的患者检测结果呈阳性。根治性前列腺切除术和前列腺穿刺活检对RT-PCR检测的影响可以忽略不计。根治性前列腺切除术后的结果是可变的，但许多术前RT-PCR阳性的男性术后变为RT-PCR阴性。结论：本实验室PSA RT-PCR检测不能用于术前预测前列腺癌病理分期及治疗失败。大多数术前呈阳性的病例术后呈阴性。虽然肿瘤负荷的增加增加了阳性试验的可能性，但在外周血中使用这种试验似乎存在显著的抽样误差。
Purpose: The reverse transcriptase polymerase chain reaction (RT-PCR) assay is an extremely sensitive technique of detecting cells expressing prostate specific antigen (PSA). Controversy exists regarding the ability of peripheral blood PSA RT-PCR testing to reflect pathological staging or treatment outcome. We examine the phenomenology of RT-PCR results in patients with prostate cancer, with particular emphasis on the RT-PCR test before and after radical prostatectomy, and correlations with pathological staging and treatment outcome.Materials and Methods: Peripheral blood was obtained from a wide variety of patients with and without prostate cancer, including before and after radical prostatectomy. After ribonucleic acid isolation, complementary deoxyribonucleic acid was generated and amplified with a hot-start technique. RT-PCR results were compared with pathological stage, Gleason score, tumor volume and disease-free status. Correlations between preoperative and postoperative RT-PCR tests were also made.Results: The RT-PCR test was positive in 1 of 56 controls (1.8%) without suspicion of prostate cancer. A positive test was obtained in 12 of 65 men (18.5%) with a suspicion of prostate cancer but a negative biopsy. Before radical prostatectomy a positive test was obtained in 13 of 75 men (17.3%) with pT2 disease versus 10 of 46 (21.7%) with pT3 disease. There was no significant difference in serum PSA, Gleason score or tumor volume between the men with positive or negative results. With repetitive testing an increasing percentage of men had at least 1 positive test preoperatively. With a median followup of 8 months 6 of the 7 patients in whom radical prostatectomy failed had had negative RT-PCR before treatment. Of patients with known metastatic disease or failed primary treatment a positive test was obtained in 32 to 75%. Radical prostatectomy and prostate needle biopsy appeared to have a negligible effect on RT-PCR tests immediately following these procedures. Following radical prostatectomy results were variable but many men who are RT-PCR positive preoperatively become RT-PCR negative postoperatively.Conclusions: The PSA RT-PCR test in our laboratory cannot be used preoperatively to predict pathological stage of prostate cancer or treatment failure. Most cases that are positive preoperatively become negative postoperatively. While increasing tumor burden increases the likelihood of positive tests, there appears to be significant sampling error associated with the use of this test in the peripheral blood.