RT-PCR检测神经母细胞瘤患儿化疗后骨髓PGP9.5mRNA表达在预后判断中的意义

Detection of PGP9.5 expression in bone marrow by RT-PCR after induction chemotherapy in neuroblastoma：relationship with clinical outcome

摘要:

目的：该研究试图阐明诱导化疗后在转录水平清除骨髓肿瘤细胞能否取得好的疗效。方法：应用以PGP9.5为靶基因的逆转录聚合酶链式反应(RT-PCR)技术,其敏感性为106个细胞,测定32例发病时组织学存在骨髓转移的神经母细胞瘤患者,测定初诊及诱导治疗结束后骨髓肿瘤细胞水平。入选病例须在诱导治疗后用免疫组织化学法测定骨髓瘤细胞阴性。结果：32例患者诊断时骨髓PGP9.5mRNA均阳性,诱导结束后16例仍阳性,自体骨髓移植后随访3.4±0.9年11例复发,无病生存率31%;16例阴转,骨髓移植后随诊3.2±0.7年仅有5例复发,无病生存率69%,两组无病生存率有显著性差异(P=0.018)。结论：诱导治疗在转录水平清除骨髓神经母细胞瘤后行自体骨髓移植可以取得较好疗效。

Abstract:

OBJECTIVE: This study aimed to investigate the effect of clearance of tumor cells in autologous bone marrow after induction chemotherapy (based on RT-PCR detection) on the outcome in patients with neuroblastoma. METHODS: Thirty-two neuroblastoma patients with histological bone marrow metastasis at diagnosis but without tumor cells in marrow based on the immunohistochemistry detection after induction therapy were eligible to this study. The neuroendocrine protein gene product 9.5 (PGP9.5) was measured with RT-PCR, as a bio-marker to detect the presence of tumor cells in bone marrow at diagnosis and after induction chemotherapy. RESULTS: All patients were PGP9.5 positive in bone marrow at diagnosis. After induction chemotherapy, 16 patients remained PGP9.5 positive in marrows. A 3.4±0.9 year-follow-up showed a relapse in 11 out of the 16 patients, with event free survival (EFS) of 31%. In contrast, among the other 16 PGP9.5 negative patients, only 5 relapsed after (3.2±0.7 years) treatment, with EFS of 69%(P = 0.018). Conclusions Clearance of neuroblastoma cells through induction chemotherapy (based on RT-PCR detection) in autologous bone marrow is associated with better prognosis in patients with neuroblastoma.