Real-time PCR判断前列腺癌盆腔淋巴结微转移的价值

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

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-timePCR方法检测淋巴液内PSA mRNA和PSMA mRNA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PSA mRNA和PSMA mRNA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-time 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。

[ Objective ] To confirm the values of real-time PCR for judgment of pelvic lymph nodes micrometasta- sis 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 fluoro- scope before RRP. Then we detected the PSAmRNA and PSMAmRNA expression of the lymph fluid and the speci-men 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 bemissed because it is hard to identify the degenerative prostate cancer cells by pathology. The Real-time PCR detect- ed the PSAmRNA and PSMAmRNA expression of the lymph fluid could be in favor of diagnosing lymph node mi- crometastasis after neoadjuvant therapy,which may provide the reliable diagnostic evidence fc,r clinical stage before prostate cancer operation.