老年前列腺癌患者中预测活检阳性率的相关参数分析研究  

Study on Variables of Predicting Positive Prostate Biopsy in the Elderly Patients with Prostate Cancer

作　　者：张建[1] 顾茵[1] 罗学胜[1] 李琦[1] 陈穗[1] 王珊珊[1] 孟艳玲[1] 

机构地区：[1]宁波市解放军第113医院干部病房,中国宁波315040

出　　处：《国际老年医学杂志》2014年第6期250-253,共4页International Journal of Geriatrics

摘　　要：目的：为了评估老年前列腺癌患者中相关的参数包括年龄、家族史、前列腺体积、前列腺特异性抗原（PSA）、游离前列腺抗原（FPSA）、游离前列腺抗原（FPSA）／总前列腺抗原（TPSA）、PET－CT或者ECT检查阳性率在预测前列腺穿刺活检率的价值。方法：患者资料是从2008年7月～2013年10月期间我院被初步诊断为老年前列腺癌患者162例，在前列腺活检前行PET－CT或者ECT检查。逻辑回归分析来评估各参数的相关的风险性。建立回归方程式通过逐步回归的各项参数来评估阳性活检的结果，通过ROC分析使用接收区域的方式来评估预测价值。PET－CT或者ECT检查检测的肿瘤发生的准确率和活检结果的比较用卡方检验。结果：在这些患者中通过活检检测出前列腺癌的有60例患者（36．9％）。u分析显示各项相关参数在患者诊断中均是影响因素，其中AUC值为0．8657。PET－CT或者ECT检查结果提示有前列腺癌或者有骨转移提示的患者为120例。统计结果提示影像学表现与活检结果之间并没有相关性，肿瘤的影像学表现并不是显著的预测因素。预测活检结果最为准确的参数是FPSA／TPSA（P=0．002）。结论：各项参数在老年前列腺癌患者诊断中均是影响因素，合并各项参数的因素要比依靠单一参数而言可以明显提高预测活检率的准确性。确诊老年前列腺癌诊断上单纯通过PET－CT或者ECT检查上是有疑问的，影像学技术提供的诊断结果与PSA化验和活检结果比较更没有意义。OBJECTIVE： To evaluate the diagnostic value of clinical variables including age, family history, prostate volume, prostate - specific antigen, free prostate - specific antigen （ FPSA）, FPSA/TPSA, appearance of tumour by PET - CT or ECT test in the elderly with prostate carcinoma. METHODS： Totally 162 elderly patients with prostate cancer in our hospital fom July in 2008 to October in 2013 were enrolled in this study and they took the biopsy and PET - CT or ECT test. Logistic regression analysis was per- formed to estimate the relative risk. The positive biopsy results were assessed by nomogram and then the predictive value of clinical variables was evaluated using receiver area under curve （ROC） analysis. Accuracy of tumour localization tested by DW - MRI and bi- opsy findings was analysed by the chi - squared test. RESULTS： Of these 162 patients, the cancer was detected in 60 patients （36. 9% ） via biopsies. Univariate analysis showed that clinical variables were the influencing factors of the nomogram, with an AUC （ROC） of 0. 8657. PET- CT or ECT test revealed an anatomical lesion of cancer in 120 patients. There was no associations between tumour appearance on PET - CT or ECT test and biopsy findings. Appearance of tumour was not a significant predictor of treatment change. The only variable predicting treatment change was higher FPSA/TPSA （P = 0. 002）. CONCLUSION ： Every clinical varia- bles are the influencing factors of predicting positive prostate biopsy among elderly prostate cancer patients, which is significantly accu-rater than that of the prediction based on only variables. Localized low - grade prostate cancer is ehallenging to visualize in PET - CT or ECT test, and this imaging technique provides no additional prognostic benefit compared to PSA and repeat biopsies.

关 键 词：老年 前列腺癌 预测 活检阳性率 参数 

分 类 号：R737.25[医药卫生—肿瘤]