α-甲酰辅酶A消旋酶和高分子量细胞角蛋白在前列腺中的表达及其意义

Expression and significance of α-methylacyl-CoA racemase and high molecular weight cytokeratin in prostatic tissue

【目的】通过对可能的前列腺癌的诊断指标进行全面的回顾性分析,以明确对前列腺癌的诊断和鉴别诊断有临床意义的指标。【方法】自2002年1月-2005年12月,收集病理标本的各类前列腺手术病例358例,包括前列腺癌60例,前列腺上皮内瘤(PIN)38例,良性前列腺增生(BPH)260例,所有病例均经术后病理确诊。对分析资料中前列腺癌的临床分期、前列腺癌的病理分级、PIN的病理分级以及相关病理免疫组化指标等因素,使用SAS统计软件进行统计学处理。用Cochran-Mantel-Haenszel检验对免疫组化指标与前列腺癌的诊断之间的关系进行统计分析。同时对免疫组化指标AMACR、HCK对前列腺癌诊断的敏感度、特异度及Kappa系数等进行统计分析。【结果】AMACR在前列腺癌、PIN和BPH中表达的阳性率分别为90.2%、39.47%和0,差异具有统计学意义。HCK在前列腺癌、PIN和BPH中表达的阳性率分别为18.97%、86.84%和90%,差异具有统计学意义。AMACR诊断前列腺癌的敏感度为90.20%,特异度为94.97%,Kappa系数为0.7876。HCK作为阴性指标诊断前列腺癌的敏感度为81.03%,特异度为89.60%,Kappa系数为0.2795。【结论】AMACR、HCK均是较好的前列腺癌的诊断指标;两者联合诊断具有良好的应用前景。

[Objective] To identify the significant markers in the diagnosis and differential diagnosis of PCa by comprehensive retrospective analysis. [Methods] From Jan 2002 to Dec 2005, a total of 358 specimens, including 60 PCa. 38 PIN and 260 BPH were obtained from the the surgical department. All cases were confirmed by pathology. The dafa in patients with clinical stage of prostate cancer, pathological stage of PIN as well as pathological grode-related pothological immunohisto-chemistry and other indicators were analyzed with SAS software. The relation between the immunohistochemical markers and the diagnosis of PCa were anlyzed by Cochran-Mantel-Haenszed test. The sensitivity, specificity and Kappa coefficient of common markers such as AMACR, HCK in diagnosing PCa were also analyzed statistically. [Results] The positive rate of AMACR in the PCa, PIN and BPH was 90.2%, 39.47% and 0 respectively. The difference between the 3 groups was significant. It was also found that the difference of AMACR on the expression between PCa and PIN, PCa and BPH, PIN and BPH was significant. The positive rate of HCK in the PCa, PIN and BPH was 18.97 %, 86.84% and 90% respectively. The difference between the 3 groups was significant. It was found that the difference of HCK on the expression between PCa and PIN, PCa and BPH was significant, while there was no difference between PIN and BPH. The sensitivity of AMACR as a positive marker was 90.20%, the specificity was 94.97%, and the Kappa coefficient was 0.7876. The sensitivity of HCK as a negative marker was 81.03%, the specificity was 89.60%, and the Kappa coefficient was 0.2795. The sensitivity of LCK as a negative marker was 17.5%, the specificity was 98.99%, and the Kappa coefficient was 0.0401. [Conclusions] AMACR and HCK are all efficient markers for the diagnosis of prostate cancer.