超声引导下前列腺穿刺联合外周血循环肿瘤细胞检测对前列腺癌预后分析  

Prediction effect of ultrasound-guided prostate puncture combined with circulation tumor cells enumeration on prognosis of prostate cancer

作　　者：王志国[1] 王友志[1] 许长宝[1] 刘昌伟[1] 郝斌[1] Wang Zhiguo;Wang Youzhi;Xu Changbao;Liu Changwei;Hao bin(the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450013,China)

机构地区：[1]郑州大学第二附属医院泌尿外科

出　　处：《中华细胞与干细胞杂志（电子版）》2019年第6期327-332,共6页Chinese Journal of Cell and Stem Cell（Electronic Edition）

摘　　要：目的探讨超声引导下前列腺穿刺联合外周血循环肿瘤细胞(CTCs)检测对前列腺癌预后的预测效果。方法选取2011年1月至2017年12月期间于郑州大学第二附属医院收治的83例前列腺癌患者为研究对象,全部患者均根据超声引导下经直肠前列腺穿刺活检术确诊为前列腺癌,检测病理标本中CK34BE12、p63、α-甲酰基辅酶A消旋酶(AMACR)等免疫标志物的表达状况,并采用Cell Search细胞搜索系统检测外周血CTCs的数量,据此分为阳性组(≥5个/7.5 ml)和阴性组(<5个/7.5 ml)。分析穿刺组织中免疫标志物表达状况、外周血CTCs计数与患者临床病理特征、生存状况的相关性。各标志物的阳性例数、Gleason评分>7分的比例、TNM分期等定性资料的比较采用x^2检验或Fisher确切概率法,年龄、血常规、凝血功能、肝功能、PSA水平等定量资料的比较采用t检验。采用Kaplan-Meier法进行生存分析,采用多因素Cox比例风险回归模型分析患者预后的预测因素。结果(1)全部患者中外周血CTCs、穿刺组织中CK34BE12、p63、AMACR的阳性率分别为31.33、3.61、3.61、86.75。CTCs阳性组的AMACR阳性率为100.00,高于CTCs阴性组的80.70,差异有统计学意义(x^2=4.227,P<0.05)。(2)AMACR阳性组患者的血红蛋白(HB)低于AMACR阴性组[(123.66±13.33)g/L比(134.89±20.08)g/L,t=2.420,P=0.018],血小板(PLT)、血清谷丙转氨酶、D-二聚体(DD)、前列腺特异抗原(PSA)水平、Gleason评分>7分的比例均高于AMACR阴性组[(197.23±36.98)×10^9/L比(172.83±33.33)×10^9/L,t=2.062,P=0.042;(38.80±10.03)U/L比(31.46±7.83)U/L,t=2.317,P=0.023;(255.00±38.80)μg/L比(220.81±30.99)μg/L,t=2.785,P=0.007;(26.60±12.23)ng/ml比(17.90±8.88)ng/ml,t=2.263,P=0.026;45.83比9.09,x^2=3.916,P=0.048],差异有统计学意义(P<0.05)。CTCs阳性组患者的HB低于CTCs阴性组[(121.69±15.89)g/L比(132.73±18.85)g/L,t=2.767,P=0.007],血清碱性磷酸酶、DD、PSA水平、Gleason评分>7分、T3~T4期、M1期的Objective To investigate the prediction effect of ultrasound-guided prostate puncture combined with circulation tumor cells(CTCs)enumeration on prognosis of prostate cancer.Methods 83 patients with prostate cancer admitted to our hospital from January 2011 to December 2017 were enrolled for the study.All patients were diagnosed as prostate cancer by ultrasound-guided transrectal prostate biopsy,and the expression of immune markers including CK34BE12,p63 andα-methylacyl CoA racemase(AMACR)in pathological specimens were detected.Cell Search system was performed to detect the number of CTCs in peripheral blood,which was divided into positive group(>5/7.5 ml)and negative group(<5/7.5 ml).The correlations of the expression of immune markers in biopsy tissues,the number of CTCs in peripheral blood and the clinicopathological features and survival status of patients were analyzed.The number of positive cases of each marker,the proportion of Gleason score>7 points,TNM stage and other qualitative data were compared by x^2 test,and the quantitative data such as age,blood routine test,coagulation function,liver function and PSA level were compared by t test.Kaplan Meier method was used for survival analysis,and multivariate Cox proportional risk regression model was used to analyze the prognostic factors.Results(1)The positive rates of CTCs in peripheral blood,CK34BE12,p63 and AMACR in biopsy tissues were 31.33,3.61,3.61 and 86.75 respectively.The positive rate of AMACR in CTCs positive group was 100.00,and significantly higher than 80.70 in CTCs negative group(x^2=4.227,P<0.05).(2)Hemoglobin(HB)of AMACR positive group was significantly lower than that in AMACR negative group[(123.66±13.33)g/L vs(134.89±20.08)g/L,t=2.420,P=0.018].Platelet(PLT),serum levels of alanine aminotransferase,D-dimer(DD),prostate specific antigen(PSA)and proportion of Gleason score>7 in AMACR positive group were significantly higher than those in AMACR negative group[(197.23±36.98)×10^9/L vs(172.83±33.33)×10^9/L,t=2.062,P=0.042;(38.80±10.03)

关 键 词：前列腺癌 超声引导 前列腺穿刺 循环肿瘤细胞 AMACR 预后 

分 类 号：R73[医药卫生—肿瘤]