雌激素受体在前列腺癌中的表达分布及预后意义

Distribution and prognostic significance of estrogen receptors expression in prostate cancer

目的探讨雌激素受体（estrogen receptor，ER）α、β在前列腺癌及癌旁组织中的表达情况及其与临床病理参数和预后的关系。方法收集2007年8月至2010年10月因前列腺癌行腹腔镜下根治性前列腺切除术患者的临床及病理资料。采用免疫组化方法分别检测ERa、Enl3在85例根治性切除前列腺腺癌标本中的癌、癌旁组织，以及29例良性前列腺增生组织中的表达。采用Spearman相关系数分析ERa、Enl3表达与临床病理资料的相关性，采用Cox风险回归模型分析前列腺癌术后生化复发的危险因素。结果前列腺癌、癌旁和良性增生组织3组间比较，ERa在上皮细胞的表达阳性率分别为0（0／85）、11．8％（10／85）、24．1％（7／29），差异有统计学意义（P=0．000），在间质细胞的阳性率分别为52．9％（45／85）、67．1％（57／85）、31．0％（9／29），差异有统计学意义（P=0．003）；Enl3在上皮细胞的表达阳性率分别为36．5％（31／85）、61．2％（52／85）、100．0％（29／29），差异有统计学意义（P=0．000），在间质细胞的阳性率分别为49．4％（42／85）、72．9％（62／85）、79．3％（23／29），差异有统计学意义（P=0．001）。癌组织间质细胞ERα表达与PSA水平（r＝0．296，P=0．006）和Gleason评分（r=0．404，P=0．000）呈正相关。ERβ在癌组织上皮细胞（r=－0．254，P=0．019）和间质细胞（r=－0．315，P＝0．003）的表达与Gleason评分呈负相关。多因素分析结果显示，癌组织上皮细胞ERβ阴性表达（HR=0．107，95．O％C10．019—0．592，P=0．010）是前列腺癌根治术后生化复发的独立危险因素。结论ERα、Enβ在前列腺癌组织、癌旁组织和良性前列腺增生组织中的表达水平存在差异。前列腺癌恶性程度与ERα、ERβ表达存在相关性，其中ERβ在癌组织上皮细胞的表达是根治术后生化复发的独立预后因素。

Objective To evaluate the expressions of estrogen receptor （ER）α and β in human prostate cancer and adjacent non-cancerous tissues, and to evaluate the correlation between the expression and the clinicopathological features and prognosis. Methods Immunohistochemical staining was used to detect ERa and ERβ in 85 prostate adenocarcinoma tissues, adjacent non-cancerous tissues, and 29 benign prostatic hyperplasia （BPH） tissues. The correlation between the expression and the clinicopathological fea- tures was analyzed by Spearman＇s coefficient. Cox＇s proportional hazards regression model was used to iden- tify the risk factors for biological recurrence. Results There were significant differences between the ex- pression of ERa in prostate cancer, adjacent non-cancerous tissues, and BPH [ epithelial cell 0 （0/85）, 11.8% （10/85） and 24.1% （7/29）, P = 0. 000; and in stromal cell 52.9% （45/85）, 67. 1% （57/ 85）, 31.0% （9/29）, P = 0. 0031. There were significant differences between the expression of ER[3 in these groups [epithelial cell 36.5% （31/85）, 61.2% （52/85）, 100.0% （29/29）, P =0.000; and instromal cell 49.4% （42/85）, 72.9% （62/85）, 79.3% （23/29）, P=0.001]. The ERa expression in cancerous stromal cells was positively correlated with the PSA level （ r = 0. 296, P = 0. 006） and Gleason score （r = 0. 404, P = 0. 000）. The ER[3 expression was negatively correlated with Gleason score in cancer- ous epithelial cells （r = - 0. 254, P = 0. 019） and stromal cells （ r = - 0. 315, P = 0. 003 ）. Multivariate analysis revealed that negative expression was an independent poor prognostic factor for the biological recur- rence free survival after radical prostateetomy （ HR = O. 107, 95.0% CI O. 019 - O. 592, P = O. 010）. Conclusions There were significant differences between the expression of ERa and ERβ in prostate cancer, adjacent non-cancerous tissues, and BPH. ERα in cancerous stromal cells, ERβ in cancerous epi- thelial and stromal cells were related to the differentiation of prostate adenocarcinoma. ERβ in cancerous epi- thelial cells can be used as an independent prognostic factor for biological recurrence after radical surgery.