前列腺特异性抗原密度对临床局限性前列腺癌术后病理包膜外侵犯的预测价值  

The value of prostate-specific antigen density in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer

作　　者：许清江[1] 许恩赐[1] 李梦强[1] 

机构地区：[1]福建医科大学附属协和医院泌尿外科,福州350001

出　　处：《中华泌尿外科杂志》2015年第12期910-913,共4页Chinese Journal of Urology

摘　　要：目的 采用MRI图像计算前列腺体积,探讨前列腺特异性抗原密度（prostate-specific antigen density,PSAD）对临床局限性前列腺癌术后病理包膜外侵犯的预测价值.方法 回顾性分析福建医科大学附属协和医院泌尿外科2009年1月全2013年12月施行根治性前列腺切除术的71例临床局限性前列腺癌患者的临床资料.收集术前MRI PSAD及tPSA、fPSA/tPSA、前列腺穿刺活检Gleason评分、前列腺体积、年龄、体质指数,比较术后病理包膜外侵犯组和器官局限组以上指标的差异,运用受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）比较各指标的预测价值.并通过多因素Logistic回归分析筛选包膜外侵犯的独立影响因素.结果 71例患者中32例（45.1％）发现术后包膜外侵犯,39例（54.9％）为器官局限者.单因素分析结果显示,包膜外侵犯组MRI PSAD（P＜0.001）、tPSA （P ＜0.001）、前列腺穿刺活检Gleason评分（P =0.006）均高于器官局限组,前列腺体积低于器官局限组（P=0.009）;在ROC曲线下对术后病理包膜外侵犯的单因素预测比较,MRI PSAD的ROC曲线下面积（area under curve,AUC）最大（AUC=0.852,P＜0.001）,其次为tPSA（AUC=0.764）.多因素分析结果显示,仅MRI PSAD是术后病理包膜外侵犯的独立预测因子.结论 MRI PSAD在临床局限性前列腺癌术后病理包膜外侵犯预测中具有较好的价值,其价值优于tPSA.PSAD对前列腺癌病理分期的评估价值不应忽视.Objective To evaluate the role of PSA density with prostate volume determined by MR images in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer.Method A total of 71 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 2009 to December 2013 were included in the study.MRI PSAD,preoperative total serum PSA （tPSA）,free PSA/total PSA （fPSA/tPSA）,biopsy Gleason score,prostate volume,age,body mass index in patients with extraprostatic extension were compared with those in patients with organ-confined disease.The receiver operating characteristic （ROC） curve was used to analyze the performance of each of the above parameters to predict the extraprostatic extension.Multivariate logistic regression analysis was used to select the independent influencing factors for extraprostatic extension.Results Pathologic examination revealed 32 patients were positive for extraprostatic extension and 39 paticnts had organ-confined disease.MRI PSAD（P 〈 0.001）,tPSA （P 〈 0.00l） and biopsy Gleason score levels （P =0.006） were higher in patients with extraprostatic extension than that in patients with organ-confined disease,and prostate volume was lower（P =0.009）.MRI PSAD showed the largest area under ROC curve （AUC） among those parameter（AUC =0.852,P 〈 0.001）,and tPSA was the second （AUC =0.764）.Multivariate logistic regression analyses showed that MRI PSAD was an independent predictor of extraprostatic extension.Conclusions MRI PSAD was better than tPSA in predicting pathological stage of extraprostatic extension.The value of PSAD should not be ignored in the prediction of pathological stage.

关 键 词：前列腺肿瘤 前列腺特异性抗原 前列腺特异性抗原密度 病理分期 包膜外侵犯 

分 类 号：R737.25[医药卫生—肿瘤]