前列腺癌生物标志物研究进展

doi:10.3969/j.issn.1673-8640.2023.02.018

摘要/Abstract

摘要：

前列腺癌是男性常见的恶性肿瘤之一，具有较高的发病率和致死率。前列腺特异性抗原（PSA）在前列腺癌筛查中意义重大。随着前列腺癌诊疗研究的深入，各类生物标志物不断被发现，在前列腺癌诊疗全过程发挥着重要作用。使用血液或尿液样本的前列腺健康指数（PHI）、4K评分、PCA3、精选MDx、外泌体智能积分等指标可以有效辅助前列腺的筛查和诊断。血液循环肿瘤细胞（CTC）、循环肿瘤DNA（ctDNA）可用于前列腺癌的风险分层和治疗药物选择、治疗反应监测，以及临床试验替代终点。使用前列腺癌组织样本的基因组前列腺积分、Prolaris积分等可用于前列腺癌的风险分层。文章就基于血液、尿液和其他类型样本的各类前列腺癌生物标志物的临床应用进行综述。

关键词: 前列腺特异性抗原, 前列腺健康指数, 循环肿瘤细胞, 循环肿瘤DNA, 外泌体, 前列腺癌

Abstract:

Prostate cancer is one of the most common cancers in males，and it has high incidence rate and mortality rate. Prostate-specific antigen（PSA） plays a role in prostate cancer screening. With the research progress of prostate cancer diagnosis and treatment，various biomarkers have emerged，which play a role in the whole process of prostate cancer diagnosis and treatment. Prostate health index（PHI），4K score，PCA3，selected MDx and exocrine intelligence scores，can effectively assist in the screening and diagnosis of prostate cancer. Blood circulating tumor cells（CTC） and circulating tumor DNA（ctDNA） can be used for the risk stratification of prostate cancer and the selection of therapeutic drugs，therapeutic responses and alternative endpoints of clinical trials. Genomic prostate score and Prolaris score of prostate cancer tissue samples can be used for prostate risk stratification. This review focuses on various biomarkers of prostate cancer in blood，urine and other specimen types.

Key words: Prostate-specific antigen, Prostate cancer, Prostate health index, Circulating tumor cell, Circulating tumor DNA, Exosome

中图分类号:

R446.1

吴炯, 胡嘉华, 施美芳, 刘涛, 戴洁, 卢忻怡, 邹政. 前列腺癌生物标志物研究进展[J]. 检验医学, 2023, 38(2): 190-195.

WU Jiong, HU Jiahua, SHI Meifang, LIU Tao, DAI Jie, LU Xinyi, ZOU Zheng. Research progress of biomarkers of prostate cancer[J]. Laboratory Medicine, 2023, 38(2): 190-195.

图/表 1

参考文献 43

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项目	样本类型	指标
筛查和诊断
PSA	血液	PSA
PHI	血液	PHI=p2PSA /游离PSA×（总PSA）^1/2
4K评分	血液	基于总PSA、游离PSA、iPSA、hK2和患者临床参数计算
PCA3	尿液	尿液外泌体中PCA3表达
精选 MDx	尿液	尿液HOXC6 mRNA和DLX1 mRNA水平
外泌体智能积分	尿液	尿液外泌体mRNA
Prostarix积分	尿液	尿液肌氨酸、丙氨酸、甘氨酸和谷氨酸水平
TMPRSS2-ERG	尿液	TMPRSS2-ERG融合产物
风险分层
AR-V7	血液	CTC中的AR-V7
基因组前列腺积分	前列腺活检组织	17个基因组合
Prolaris积分	前列腺活检组织	46个基因的RNA表达
Decipher积分	前列腺活检组织	17个基因组成的积分系统
ProMark积分	前列腺活检组织	8个蛋白类标志物（GUL2、DERL1、FUS、HSPA9、PDSS2、pS6、SMAD4、YBX1）
治疗药物相关
CTC	血液	根据CTC的不同物理或生物特征进行分离
ctDNA	血液	全外显子或全基因组测序分析特定突变
ctDNA	血液	TP53突变、DDR基因等靶向基因测序
ctDNA	血液	采用ddPCR检测AR突变和拷贝数

项目	样本类型	指标
筛查和诊断
PSA	血液	PSA
PHI	血液	PHI=p2PSA /游离PSA×（总PSA）^1/2
4K评分	血液	基于总PSA、游离PSA、iPSA、hK2和患者临床参数计算
PCA3	尿液	尿液外泌体中PCA3表达
精选 MDx	尿液	尿液HOXC6 mRNA和DLX1 mRNA水平
外泌体智能积分	尿液	尿液外泌体mRNA
Prostarix积分	尿液	尿液肌氨酸、丙氨酸、甘氨酸和谷氨酸水平
TMPRSS2-ERG	尿液	TMPRSS2-ERG融合产物
风险分层
AR-V7	血液	CTC中的AR-V7
基因组前列腺积分	前列腺活检组织	17个基因组合
Prolaris积分	前列腺活检组织	46个基因的RNA表达
Decipher积分	前列腺活检组织	17个基因组成的积分系统
ProMark积分	前列腺活检组织	8个蛋白类标志物（GUL2、DERL1、FUS、HSPA9、PDSS2、pS6、SMAD4、YBX1）
治疗药物相关
CTC	血液	根据CTC的不同物理或生物特征进行分离
ctDNA	血液	全外显子或全基因组测序分析特定突变
ctDNA	血液	TP53突变、DDR基因等靶向基因测序
ctDNA	血液	采用ddPCR检测AR突变和拷贝数