摘要
目的
统计分析PSA、PAP、HCK、P63、AMACR的表达,以探讨其在前列腺病变诊断中的实际应用价值
方法
选取湘雅三医院泌尿外科收治的经病理组织形态学确诊的前列腺病人121例,年龄56-86岁,平均67岁。其中前列腺癌病人63例,非前列腺癌组病人58例.非前列腺癌组中,BPH、IGPIN、HGPIN、AAH分别为31例、17例、4例、6例。前列腺癌组病人中,按照Gleason分级标准,5-6分13例、7分23例、8-9分27例。所有前列腺组织标本,均经PSA、PAP、HCK、P63、AMACR五项指标免疫组化染色。
结果
1、回归方程建立的数学模型可以准确的对前列腺良恶性病变的性质作出科学的诊断
5项免疫组化指标中HCK、P63、AMACR被引入方程,对良恶性的鉴别诊断有明显的影响。
2、PSA和PAP均显示了其在前列腺组织中的高敏感性：PSA:91.7%(111/121)、PAP:94.2%(114/121);前列腺良恶性组织中PSA表达与PAP的表达间无相关性(P>0.05)。
3、HCK、P63两者在三种前列腺良性病变中均显示了高表达,而在前列腺癌组中则低表达；均可作为基底细胞标记物。HCK比P63更敏感和特异,可以将HCK作为首选抗体。
4、AMACR显示了在前列腺癌组中的高表达,而在三种前列腺良性病变中均低表达。
5、AMACR与基底细胞首选抗体HCK联合应用,可以提高诊断准确率。
6、5种标记物染色阳性在Gleason评分三组间表达无统计学差异。
结论
1、可以将HCK作为基底细胞标记物的首选抗体；对于组织形态学诊断有困难病例,建议将HCK+AMACR作为常规标记物。
2、不建议将PSA和PAP作为常规使用的标记物,仅在临床及组织形态学指向有异常时,选用组织特异性标记物。
3、PSA、PAP、HCK、P63、AMACR表达阳性和Gleason评分之间无相关性,5项指标对恶性程度的评价,及预后评估没有价值。
Objective
Analyze the value of PSA、PAP、HCK、P63 and AMACR immunostaining for the diagnosis of benign and malignant lesions of prostate
Methods
All the samples,121 cases of prostrate specimens, including 63 prostate cancer、30 BPH、17IGPIN、4 HGPIN、6 AAH, were confirmed by histomorphology and measured for PSA、PAP、HCK、P63 and AMACR by immunohistochemistry.
Logistic regression,χ2 tests and nonparametric tests were used to analyze the value of PSA、PAP、HCK、P63 and AMACR immunostaining for the diagnosis of benign and malignant lesions and the relationship to Gleason.
Results
1、Logistic model can accuratetly separate malignant from benign prostate lesions Variable selection basic on a set of 3 variables for the models:HCK、P63、P504S.
2、Both PSA and PAP show high sensitivities for prostate lesions, 91.7%(111/121).94.2%(114/121), respectively.There is no significant difference between the expression of PSA and PAP in all cases (P>0.05)
3、Both HCK and P63 show high level sensitivities in 3 groups of benign lesions groups and low level sensitivities in prostate cancer group.When we evaluated the correlation of basal cell markers.We did not find any complementary staining results among basal cell markers.Both HCK and P63 are basal cell-specific marker, but HCK is more sensitive and specific.
4、AMACR show high level expression in prostate cancer group and low level expression in bening lesions groups.
5、AMACR shows false positive in benign prostate lesions and basal cell-specific markers show fales negative in prostate cancer;The application of AMACR combined with the first basal cell-specific marker—HCK may be of greater benefit in diagnosis of prostate cancer, a positive resule for P504S can assist the diagnosis of prostate cancer, while a staining for HCK and P63 may help to eliminate cancerous changes of a prostate.
6、All prostate cancer cases enrolled into three groups depend on Gleason score.The first group 5-6 scores, the second group 7 scores, the third group 8-10 scores.The expression of PSA, PAP, HCK, P63 and AMACR were not correlated with degrees of Gleason scroe.
Conclusions
1、We suggest that HCK should be the first choice as a basal cell marker.P63 can be used together with HCK, but it may not give additional diagnostic information.
Our study showed that HCK is a appropriate negative marker to combine with AMACR as a positive marker for the diagnosis of prostate adenocarcinoma, AMACR+HCK should be as routine markers.
2、We did not recommend PSA and PAP as routine markers
3、The expression of PSA、PAP、HCK、P63 and AMACR were not correlated with degrees of Gleason score,so the expression of these markers have not the guiding significance for establishment of the therapeutic principles of the prostate cancer patients, and are not helpful in the evaluation of prognosis
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