前列腺穿刺活检Gleason评分≤7患者术后发生具有临床意义的Gleason评分升高预测因素分析  

Predictive factors for clinically significant elevation of post-prostatectomy Gleason score in patients with biopsy Gleason score ≤7

作　　者：郭新[1] 马利民[1] 吴优[1] 张跃平[1] 李华镭[1] 农绍军[1] 管杨波[1] 黄烨清 蔡波[1] GUO Xin;MA Li-min;WU You;ZHANG Yue-ping;LI Hua-lei;NONG Shao-jun;GUAN Yang-bo;HUANG Ye-qing;CAI Bo(Department of Urology,The Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)

机构地区：[1]南通大学附属医院泌尿外科,江苏南通226001

出　　处：《中华男科学杂志》2018年第12期1094-1099,共6页National Journal of Andrology

基　　金：南通市科技项目(BK2014044)~~

摘　　要：目的:探讨经直肠前列腺穿刺活检病理Gleason评分(b GS)≤7患者术后发生具有临床意义的Gleason评分(pGS)升高的预测因素。方法:分析2010年1月至2017年12月170例前列腺癌根治手术患者的临床病理资料,分析有临床意义p GS升高患者的年龄、术前血清总前列腺特异抗原(tPSA)、游离PSA(fPSA)、fPSA/tPSA、前列腺体积、PSA密度(PSAD)、穿刺阳性针数比等指标分布特征,评价bGS=7和bGS≤6两组患者发生具有临床意义的pGS升高的可能因素。结果:170例患者pGS与bGS保持一致者95例(55. 9%),下降者11例(6. 5%),升高者64例(37. 6%),在pGS评分升高的患者中符合"具有临床意义的术后升高"55例(32. 4%),无临床意义的术后升高9例(5. 3%)。bGS=7的患者中穿刺阳性针数比(P=0. 021)与发生具有临床意义的pGS升高显著相关,bGS≤6的患者中年龄(P=0. 018)及PSAD(P=0. 033)与发生具有临床意义的pGS升高显著相关。进一步采用受试者工作特征曲线分析得出:bGS=7患者中穿刺阳性针数比> 0. 528,而bGS≤6患者中年龄> 64. 5岁,PSAD> 0. 267μg/(L·g)患者发生具有临床意义的pGS升高的可能性增加。结论:bGS=7患者的穿刺阳性针数比在有临床意义pGS升高中有预测价值,而bGS≤6患者的年龄及PSAD在具有临床意义的pGS升高有预测价值。Objective: To investigate the prognostic factors for clinically significant increase in post-prostatectomy Gleason score( p GS) in patients with biopsy Gleason score( bGS) ≤7. Methods: This retrospective study included 170 cases of prostate cancer treated by radical prostatectomy in our hospital from January 2010 to December 2017. We analyzed the clinical and pathological data on the patients,including the age,preoperative serum tPSA,fPSA,fPSA/tPSA,prostate volume,PSA density( PSAD),and positive puncture rate of the patients with clinically significant elevation of p GS,as well as the possible factors for clinically significant pGS increase in patients with bGS = 7 and those with bGS ≤ 6. Results: The p GS was found consistent with the bGS in 95( 55. 9%) of the 170 patients,decreased in 11( 6. 5%) and increased in 64( 37. 6%). Among those with elevated p GS,55( 32. 4%) were shown with and the other 9( 5. 3%) without clinical significance. Clinically significant escalation of pGS was markedly correlated with the positive puncture rate in the patients with bGS = 7( P = 0. 021) and with the age( P = 0. 018) and PSAD( P = 0. 033) of those with bGS ≤ 6. ROC curve analysis further showed the positive puncture rate > 0. 528 in the patients with bGS = 7 and a higher risk of clinically significant p GS increase in those aged > 64. 5 years with bGS ≤ 6 and PSAD > 0. 267 μg/( L·g). Conclusion:Clinically significant elevation of p GS is correlated with the rate of positive punctures in prostate cancer patients with bGS = 7 and with age and PSAD in those with bGS ≤ 6.

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

分 类 号：R73.25[医药卫生—肿瘤]