TMPRSS2-ERG融合基因在淋巴结转移前列腺癌中的阳性率及与生存的关系

Prevalence and prognostic significance of TMPRSS2-ERG fusion gene in prostate cancer with lymph node metastasis

目的研究TMPRSS2-ERG融合基因在淋巴结阳性前列腺癌中的分布以及对其预后的意义。方法收集2008年1月至2012年12月前列腺癌根治术后,术后病理提示淋巴结转移的标本50例。所有患者术后均接受内分泌治疗。利用荧光原位杂交技术检测标本中TMPRSS2-ERG融合基因。收集患者各种肿瘤特征(Gleason评分、分期)、有无生化复发、疾病特异性和总体生存率。比较融合基因阳性和阴性患者的临床病理资料分布及预后差异。结果 19例(38%)原发性肿瘤中检测到TMPRSS2-ERG融合基因。转移淋巴结中有16例(32%)出现融合基因。原发肿瘤与转移灶TMPRSS2-ERG状态一致性较好(Kappa=0. 73)。在COX分析中,原发肿瘤中TMPRSS2-ERG融合基因与Gleason评分是生化复发的预测因素。在生存分析中,原发肿瘤/淋巴结融合基因(+/+)组与原发肿瘤/淋巴结融合基因(+/-)组预后低于原发肿瘤/淋巴结融合基因(-/-)组,无生化复发率差异存在统计学意义(P=0. 03)。结论 TMPRSS2-ERG融合基因在伴有淋巴结转移的原发性前列腺癌中阳性率38%。原发肿瘤与淋巴结转移灶中TMPRRS2-ERG融合基因具有较好的一致性。原发肿瘤TMPRSS2-ERG融合基因阳性的患者预后较差。

Objective To investigate the distribution and prognostic significance of TMPRSS2-ERG fusion gene in lymph node-positive prostate cancer. Methods Fifty cases of lymph node metastasis after radical prostatectomy from January 2008 to December 2012 were collected. All patients received endocrine therapy after operation. The TMPRRS2-ERG fusion gene was detected with fluorescence in situ hybridization. The data were correlated with various tumor features( Gleason score,stage) and biochemical recurrence-free,diseasespecificity,and overall survival. The distribution of clinicopathological data and prognosis of patients were compared with each other for the patients with positive and negative fusion genes. Results The TMPRSS2-ERG fusion gene was detected in 19 cases( 38%) of the primary tumors. Fusion genes were present in 16 cases( 32%) of the metastatic lymph nodes. The primary tumor and metastatic lesion TMPRSS2-ERG status was in good agreement( Kappa = 0. 73). The TMPRSS2-ERG fusion gene and Gleason score in primary tumors in COX analysis were predictors of biochemical recurrence. In survival analysis,the prognosis of primary tumors/lymph node fusion gene( +/+) group and primary tumors/lymph node fusion gene( +/-) group was lower than that of primary tumors/lymph node fusion gene(-/-) group,with significant difference in the non-biochemical recurrence rate( P = 0. 03). Conclusion The positive rate of TMPRSS2-ERG fusion gene in primary prostate cancer with lymph node metastasis was 38%. The fusion gene of TMPRRS2-ERG in primary tumors and lymph node metastases had good consistency( Kappa = 0. 73). Patients with positive primary tumor TMPRSS2-ERG fusion gene have a poor prognosis.