前列腺特异性抗原密度预测首次前列腺活检标本Gleason评分升高的价值  

Value of prostate-specific antigen density in predicting an upgrade in Gleason score for initial prostate biopsy

作　　者：陈超[1] 谢立平[1] 郑祥毅[1] 林奕伟[1] 朱翮嘉[1] 汪朔[1] 沈柏华[1] 蔡柏森[2] 尤启汉[3] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]浙江大学医学院附属第一医院超声科,杭州310003 [3]浙江大学医学院附属第一医院病理科,杭州310003

出　　处：《中华泌尿外科杂志》2013年第10期755-759,共5页Chinese Journal of Urology

基　　金：基金项目：卫生行业科研专项项目泌尿系统重大疾病的防治研究基金（201002010）;浙江省学科建设基金中西医结合前列腺病学（2012-XK-A23）;国家临床重点专科建设项目经费

摘　　要：目的评价前列腺特异性抗原密度（PSAD）预测临床低中危前列腺癌（PCa）患者首次前列腺活检标本的Gleason评分在根治性前列腺切除术（RP）后评分升高的能力。方法回顾性分析2008年6月至2012年10月收治的170例低中危PCa患者（PSA≤20μg／L，分期≤T2h，Gleason评分≤7分）的临床资料，中位年龄68岁，中位PSA为10．2μg／L，中位PSAD为0．35mg／L^2，中位前列腺体积为28．4ml。临床分期T1期95例，T2期75例。根据活检Gleason评分分为3组：3＋3组91例，3＋4组42例，4＋3组37例，每组内再根据RP后的Gleason评分是否升高，分为评分一致组和升高组。绘制3组的受试者工作特征（ROC）曲线并计算PSAD的曲线下面积（AUC）。结果本组170例中术后Gleason评分升高79例（46．5％），其中3＋3组51例（56．0％），3＋4组17例（40．5％），4＋3组11例（29．7％）。3＋3组中升高组的PSAD值（0．37mg／L。）高于一致组（0．23mg／L^2），差异有统计学意义（P〈0．01）。3＋4组和4＋3组中升高组的PSAD（0．33、0．49mg／L^2）与一致组（0．36、0．58mg／L^2）比较差异均无统计学意义（P〉0．05）。3＋3、3＋4、4＋3组ROC曲线的AUC分别为0．762、0．529、0．413。3组中升高组的病理分期均高于一致组，差异均有统计学意义（P〈0．05）。结论在前列腺活检确诊为Gleason评分3＋3的临床低中危PCa患者中，PSAD具有预测术后Gleason评分升高的能力。Objective To investigate the performance of PSAD as a predictor of Gleason score upgrade between initial prostate biopsy and radical prostateetomy （RP） in the patients with low or intermediate risk prostate cancers （PCa）. Methods This study comprised a retrospective analysis of data from 170 PCa patients（PSA ≤ 20 μg/L, stage ≤T2b, Gleason score ≤ 7）. The median age was 68 yrs, the median PSA was 10.2 μg/L, the median PSAD was 0.35 mg/L2 and the median prostate volume was 28.4 ml. There were 95 cases in cTl and 75 cases in cT2. According to biopsy Gleason score, patients were divided into three groups： 3＋3 （91 cases）, 3＋4 （42 cases） and 4＋3 （37 cases）. Each group was further stratified into to subgroups according to whether their RP Gleason score was concordant or upgraded. Receiver-operating characteristic （ROC） curves for predictive power of PSAD were generated for each group, and the area under the curve （AUC） was calculated. Results Of the 170 patients, 79 （46.5%） had an upgrade in Glea- son score, 51 （56.0%） in 3＋3 group, 17 （40.5%） in 3＋4 group, 11 （29.7%） in 4＋3 group, respectively. In the 3＋3 group, PSAD was significantly higher in subgroup with upgraded Gleason score compared with the subgroup of concordant Gleason score （0.37 mg/L^2 versus 0.23 mg/L^2, P〈0.01）. In the other two groups, PSAD were not of significant differences between subgroup with upgraded Gleason score and the sub- group of concordant Gleason score （0.33 mg/L^2 versus 0.36 mg/L^2, 0.49 mg/L^2 versus 0.58 mg/L^2, P〉 0.05）. ROC analysis showed a decline in AUC with increasing biopsy Gleason score. It was 0.762 for 3＋3 group, 0.529 for 3＋4 group and 0.413 for 4＋3 group. The pathologic stage in upgraded cases were more advanced in all the groups（P〈0.05）. Conclusion PSAD has the ability of predicting Glcason score upgrade after RP in the biopsy Gleason score 3＋3 PCa patients whose clinical risk stratification are low or intermediate.

关 键 词：GLEASON评分 前列腺活检 前列腺癌 前列腺特异性抗原密度 

分 类 号：R737.25[医药卫生—肿瘤]