Real-time PCR判断前列腺癌盆腔淋巴结微转移的价值

目的 确定实时定量PCR(Real-time PCR)判断新辅助治疗后前列腺癌盆腔淋巴结微转移的价值.方法 对54例临床诊断T2c-T3a的前列腺癌患者行足背淋巴管造影,对无明显淋巴结转移者行3个月新辅助治疗,根治性前列腺切除术前在X线萤光屏监视下,对盆腔可疑癌转移淋巴结行经皮穿刺抽吸淋巴液,用real-time PCR方法检测淋巴液内PSAmRNA和PSMAmRNA的表达,与同法抽取淋巴液的6例女性因膀胱癌行根治性全膀胱切除检测结果作对照,阳性表达示前列腺癌淋巴结转移.同时与术中所取淋巴结组织切片行病理和免疫组化检查结果相比较.结果 术前在可疑癌转移淋巴结抽吸液行Real-time PCR方法检测PSAmRNA和PSMAmRNA的表达中,显示23例淋巴结存在癌转移,而病理切片免疫组化检查中仅有6例淋巴结癌转移.结论 前列腺癌经新辅助治疗后,由于病理检查有时难以发现变性的前列腺癌细胞以致于漏诊,采用Real-tine PCR方法检测淋巴结抽吸液内PSA和PSMA基因表达有利于探测新辅助治疗后前列腺癌淋巴结微转移的存在,为前列腺癌术前临床分期提供可靠的诊断依据.

Diagnostic value of detecting pelvic lymph node micrometastasis by real-time PCR in prostate cancer

【Objective】 To confirm the values of real-time PCR for judgment of pelvic lymph nodes micrometastasis after neoadjuvant therapy of prostate cancer.【Method】 We performed pedal lymphangiography on 54 cases of clinical diagnosed T2c-T3a prostate cancer.The neoadjuvant therapy was administrated to cases for 3 months who had no lymph node metastasis.We aspirated lymph fluid of the susceptible lymph nodes under the X-ray fluoroscope before RRP.Then we detected the PSAmRNA and PSMAmRNA expression of the lymph fluid and the specimen got from 6 female bladder cancer cases who accepted radical cystectomy was used as control.Furthermore we also compared the lymph node pathology and immunohistology results.【Result】 The PSAmRNA and PSMAmRNA expression of the lymph fluid revealed 23 tumor metastasis cases,however,the pathology section only reported 6 positive cases by means of immunohistology method.【Conclusion】 After neoadjuvant therapy,the diagnosis may be missed because it is hard to identify the degenerative prostate cancer cells by pathology.The Real-time PCR detected the PSAmRNA and PSMAmRNA expression of the lymph fluid could be in favor of diagnosing lymph node micrometastasis after neoadjuvant therapy,which may provide the reliable diagnostic evidence for clinical stage before prostate cancer operation.