Endothelin-1: a predictor of extracapsular extension in clinically localized prostate cancer?

Autor: Thomas Perez, Frédéric Staerman, Johann Menard, Coralie Barbe, Karine Joseph, Marianne Lorenzato, Marie Dominique Azemar, Philippe Birembault, Anne Durlach
Rok vydání: 2010
Předmět:
Zdroj: BJU International. 108:E104-E109
ISSN: 1464-4096
Popis: What’s known on the subject? and What does the study add? ET-1 expression on initial prostate biopsies combined with PSA > 10 ng/ml and Gleason score ≥7 provided the best model for predicting extracapsular extension. This is useful when making treatment decisions after the diagnosis of prostate cancer. OBJECTIVE To assess the value of endothelin-1 (ET-1) expression in predicting extracapsular extension (ECE) in clinically localized prostate cancer (PCa). PATIENTS AND METHODS ET-1 expression was determined by immunohistochemistry on archival needle biopsies (NBs) from 94 patients (49 pT2 and 45 pT3a) who underwent radical prostatectomy (RP) for clinical T1-T2 PCa. Each sample was analysed independently by two pathologists blinded to the clinical data. RESULTS In univariate analysis, high ET-1 expression in NBs, pre-operative prostate-specific antigen (PSA) level >10 ng/ml, percentage of positive biopsy cores and NB Gleason score ≥7 were significantly associated with ECE as determined on subsequent RP. No significant association was found between clinical stage and ECE. In multivariate analysis, there was a significant association with high ET-1 expression in NBs (p = 0.006), pre-operative PSA level >10 ng/ml (p = 0.049), and NB Gleason score ≥7 (p = 0.002). These three pre-operative factors combined provided the best model for predicting ECE with 93.3% sensitivity, 49% specificity, 62.5% positive predictive value, 88.9% negative predictive value. The combination yielded a higher concordance index (0.760 vs 0.720) and offered a higher log partial likelihood than the same model without ET1 (112.8 vs 105.7, p = 0.01). CONCLUSIONS ET-1 expression was strongly associated with ECE and, when combined with pre-operative PSA level and Gleason score, improved the predictive accuracy of pre-operative NBs. Its assessment in patients with localized PCa might be useful when making treatment decisions. Further studies with standardisation of immunohistochemical staining and multi-institutional validation are now needed to establish the appropriate use of ET-1 staining in PCa staging and to evaluate inter-observer reproducibility.
Databáze: OpenAIRE
Externí odkaz: