前列腺癌中垂体肿瘤转化基因表达及内分泌治疗后前列腺癌无进展生存期预测因素的研究  

Relation of pituitary tumor transforming gene expression changes and prostate cancer progression after the maximum androgen blockade therapy

作　　者：曹希亮[1] 高江平[2] 韩刚[2] 文载律[3] 洪宝发[2] 张旭[2] 

机构地区：[1]解放军第九七医院泌尿外科,江苏省徐州市221004 [2]解放军总医院泌尿外科 [3]解放军总医院病理科

出　　处：《中华泌尿外科杂志》2009年第9期609-613,共5页Chinese Journal of Urology

摘　　要：目的检测垂体肿瘤转化基因（PTTG）在前列腺癌组织中的表达情况，研究PTTG表达、Gleason分级以及治疗前PSA水平等临床病理参数对无远处转移的前列腺癌患者接受雄激素最大限度阻断治疗（MAB）后肿瘤无进展生存期的预测价值。方法收集接受MAB治疗的47例无远处转移前列腺癌患者的临床资料和治疗前穿刺标本病理资料，其中接受双侧睾丸切除加抗雄激素药物治疗者30例、药物去势加抗雄激素药物治疗者17例，对肿瘤无进展生存期进行随访。采用免疫组织化学二步法检测其前列腺穿刺标本PTTG表达情况；Stata统计分析软件分析PTTG表达情况和其他临床病理资料对肿瘤无进展生存期的预测价值。结果47例前列腺癌患者中Gleason评分〈7分者17例，7分者14例，〉7分者16例。PTTG阴性表达者17例（36．2％），阳性表达者17例（36．2％），强阳性表达者13例（27．6％）。肿瘤无进展生存期平均（43．5±23．7）个月。单因素分析显示，PTTG表达情况（高表达的风险比HR=1．99±0．44，z=3．16，p=0．00，95％CI为1．30～3．06）、Gleason分级（高病理分级HR=1．95±0．48，z=2．71，P=0．01，95％CI为1．20～3．16）和治疗前PSA≥20．0ng／ml（HR=2．20±0．85，z=2．03，P=0．04，95％CI为1．03～4．70）是前列腺癌MAB治疗后肿瘤无进展生存期的影响因素。多重逐步回归分析显示只有PTTG表达情况（P=0．01）和病理分级（P=0．03）被选人最终模型。结论PTTG可能在前列腺癌发生发展过程中起重要作用。PTTG高表达、Gleason高分级是无远处转移前列腺癌患者接受MAB后肿瘤无进展生存期较短的独立预测因素。Objective To investigate the expression changes of pituitary tumor transforming gene （PTTG） in prostate cancer tissues, and analyze the predictive value of PTTG and other clinicopathological characteristics in progression-free survival of local or locally advanced prostate cancer patients who received maximum androgen blockade （MAB） therapy. Methods Specimens from local or locally advanced prostate caner patients （47 eases） were examined for the expression of PTTG by immunohistochemieal study. Other clinical parameters were studied to find out the relationship with progression-free survival. The predictive value of PTTG expression, Gleason grade, pretreatment PSA level, TNM stage and percentage of positive biopsy cores in progression-free survival of local and locally advanced prostate cancer patients were analyzed by using Stata statistic software. Results PTTG over-expressions were found in 63.8% （30/47）in local or locally advanced prostate caner specimens. The mean progression-free survival time was （43. 5 ± 23. 7）months. On univariate analysis, PTTG over-expression （P=0.00）, Gleason grade （P=0.01） and pretreatment PSA≥20 ng/ml （P= 0.04） were associated with progression-free survival in patients with local or locally advanced prostate caner after MAB. The multivariate analysis identified PTTG expression （P= 0.01）, Gleason grade （P=0.03） as the independent risk factors. Conclusions PTTG is significantly over-expressed in prostate cancer tissues indicating that PTTG may play an important role in the progression of prostate cancer. Over-expression of PTTG and high Gleason grade are independent adverse predictors of progression-free survival for patients with local or locally advanced prostate cancer.

关 键 词：前列腺肿瘤 垂体肿瘤转化基因 免疫组织化学法 肿瘤无进展生存期 雄激素最大限度阻断 

分 类 号：R686[医药卫生—骨科学]