移行区指数在PSA灰区前列腺癌预测参数优化选择中的作用  

The utility of the transition zone index for optimal predictor selection of prostate cancer in patients with intermediate PSA levels

作　　者：戚庭月[1] 陈亚青[1] 蒋珺[1] 朱云开[1] 姚晓虹[2] 王筱金[3] 

机构地区：[1]上海交通大学医学院附属新华医院超声科,上海200092 [2]上海交通大学医学院附属新华医院病理科 [3]上海交通大学医学院生物统计学教研室

出　　处：《中国男科学杂志》2012年第7期23-27,31,共6页Chinese Journal of Andrology

基　　金：基金项目资助：本项目受上海交通大学博士创新基金（编号BXJ201123）;上海市科委基础研究重点项目（编号10JC1411400）;上海市科委面上项目（编号09411963800）;上海市科委医学重点项目（编号10411952000）

摘　　要：目的探讨移行区指数（TZI）在前列腺特异性抗原（PSA）灰区（4-10ng／ml）前列腺癌（PCa）预测参数优化选择中的作用。方法对616例PSA位于灰区并接受经直肠超声（TRUS）引导的前列腺穿刺活检患者的临床资料进行回顾性分析。TRUS测量前列腺体积（PV）及其移行区体积（TZV）。运用TZI在ROC曲线中诊断敏感性及特异性最佳的界值0．47将总研究样本分为TZI≤0．47组和TZI〉0．47组。Logistic回归分析确定各组中的PCa最佳预测参数，并对各组独立预测参数的ROC曲线及其曲线下面积（AUC）进行分析。结果616例患者中，穿刺病理诊断166例（26．9％）为PCa，其余450例（73．1％）为良性病变。TZI≤0．47组包括238例（38．6％）患者，其中97例（40．8％）患者为PCa；TZI〉0．47组包括378例（61．4％）患者，其中69例（18．3％）患者为PCa。对TZI≤0．47的患者，前列腺特异性抗原密度（PSAD）为最佳预测参数，其95％敏感性诊断界值为0．12ng／ml^2；而对TZI〉0．47的患者，移行区前列腺特异性抗原密度（PSATZD）为最佳预测参数，其95％敏感性诊断界值为0．179ng／ml^2。最佳预测参数取100％敏感性时的诊断界值，TZI分组前后可避免的不必要的前列腺穿刺分别为17．7％及25％（P=0．002）。结论不同TZI组别中PCa最佳预测参数不同，对TZI≤0．47患者使用PSAD，而对TZI〉0．47的患者使用PSATZD分别作为最佳预测参数较分组前仅使用PSAD作为最佳预测参数能使更多的患者避免不必要的穿刺活检。Objective To investigate the utility of the transition zone index （TZI） for optimal predictor selection of prostate cancer （PCa） in patients with prostate-specific antigen （PSA） levels of 4 to 10 ng/ml. Methods In this retrospective cohort study, results of transrectal ultrasonography （TRUS）-guided biopsy were assessed in 616 consecutive patients; The prostate and transition zone volumes were determined by TRUS. A TZI cutoff value of 0.47 produced the best sensibility and specificity rates in receiver operating characteristic （ROC） curve analysis and thus was used to classify the study subjects into group TZI ≤ 0.47 and group TZI 〉 0.47. Logistic regression analysis was used to predict outcomes. The variables that were statistically significant in the stepwise logistic regression analysis were assessed using the ROC curve and the area under the curve （AUC）. Results Overall, 166 of the 616 patients （26.9%） had histologically confirmed PCa. A total of 238 （38.6%） patients were classified into group TZI ≤0.47, of whom 97 （40.8%） exhibited a positive biopsy, and 378 （61.4%） patients were classified into group TZI〉0.47, of whom 69 （18.3%） exhibited a positive biopsy. The stepwise logistic regression analysis revealed that PSA density （PSAD） exhibited the strongest predictive value in the overall population and in group TZI≤0.47, whereas PSA transition zone density （PSATZD） was the optimal predictor in group TZI〉0.47. The ROC curve analysis revealed that when using the TZI- specific 100% sensitivity cutoffs, 17.7% and 25% of the biopsies were unnecessary and could be avoided in the overall patient population prior to and following the division into groups, respectively （ P = 0.002）. Using an individually generated 95% sensitivity cutoff of 0.12 ng/ml 2 for PSAD and a cutoff of 0.179 ng/ml 2 for PSATZD for TZI-stratified cohorts of TZI ≤ 0.47 and TZI〉0.47, a more consistent specificity of 44% and 46.9%, respectively, for each cohort was observed. C

关 键 词：前列腺特异性抗原 前列腺肿瘤 活组织检查 针吸 

分 类 号：R737.25[医药卫生—肿瘤]