前列腺特异性抗原密度预测前列腺癌包膜侵犯的价值研究  

Prediction Value of Prostate- specific Antigen Density in Capsular Invasion of Prostate Cancer

作　　者：翁锡君 谢立平[1] 郑祥义[1] 汪朔[1] 蔡柏森[3] 项尖尖[3] 尤启汉[4] 

机构地区：[1]浙江大学附属第一医院泌尿外科,浙江省杭州市310003 [2]浙江省宁波市泌尿肾病医院 [3]浙江大学附属第一医院超声科,浙江省杭州市310003 [4]浙江大学附属第一医院病理科,浙江省杭州市310003

出　　处：《中国全科医学》2016年第20期2406-2409,共4页Chinese General Practice

基　　金：国家临床重点专科建设项目(2012泌尿外科);浙江省中西医结合前列腺病学重点学科(2012-XK-A23)

摘　　要：目的探讨前列腺特异性抗原密度(PSAD)预测前列腺癌包膜侵犯的价值。方法选取2007年3月—2014年1月于浙江大学附属第一医院泌尿外科治疗的局限性前列腺癌患者222例为研究对象,根据术后病理分期将患者分为包膜侵犯组(p T3a期,110例)和局限包膜内组(pT_2期,112例)。采用Gleason评分评价前列腺癌的分化程度。采集患者外周静脉血,以化学发光微粒子免疫法检测总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(f PSA),计算游离前列腺特异性抗原与总前列腺特异性抗原比值(f/t)。经直肠B超测定前列腺体积,计算PSAD。结果两组年龄比较,差异无统计学意义(P>0.05)。两组Gleason评分、tPSA、f/t及PSAD比较,差异均有统计学意义(P<0.05)。Gleason评分、tPSA、f/t、PSAD预测前列腺癌包膜侵犯的ROC曲线下面积(AUC)分别为0.623〔95%CI(0.549,0.697)〕、0.653〔95%CI(0.582,0.725)〕、0.338〔95%CI(0.267,0.408)〕、0.708〔95%CI(0.641,0.775)〕,且均有统计学意义(P<0.05)。PSAD最佳界点为0.27μg·L^(-1)·cm^(-3),灵敏度和特异度分别为83.6%、48.2%,阳性预测值和阴性预测值分别为47.0%、84.2%。多因素Logistic回归分析显示,高PSAD是前列腺癌包膜侵犯的危险因素〔OR=4.639,95%CI(1.303,16.514),P=0.018〕。结论 PSAD预测前列腺癌包膜侵犯具有一定的准确性,有一定的临床应用价值。Objective To discuss the predictive value of prostate- specific antigen density（ PSAD） in capsular invasion of prostate cancer. Methods 222 patients with localized prostate cancer, who were treated in the Department of Urology of the First Affiliated Hospital of Zhejiang University from March 2007 to January 2014,were selected as the study subjects. According to their postoperative pathological stages,we divided the patients into capsular invasion group（ stage pT_（3a）,n= 110） and localized in- capsule group（ stage p T2,n = 112）. The differentiation degree of prostate cancer was assessed by adopting Gleason score. After the collection of the peripheral venous blood, we detected the total prostate- specific antigen（ tPSA） and the free prostate- specific antigen（ f PSA）,and calculated the ratio of the two（ f/t）. The prostate volume was measured by transrectal B ultrasonography to calculate PSAD. Results There was no significant difference in age between the two groups（ P〉 0. 05）. There were significant differences in Gleason score,tPSA,f / t and PSAD（ 〈P 0. 05）. The areas under the ROC curve（ AUC） of Gleason score,tPSA,f / t,PSAD in predicting the capsular invasion of patients with prostate cancer were 0. 623 〔95% CI（ 0. 549,0. 697） 〕,0. 653 〔95% CI（ 0. 582,0. 725） 〕,0. 338 〔95% CI（ 0. 267,0. 408） 〕and 0. 708 〔95% CI（ 0. 641,0. 775） 〕respectively,showing significant differences（ P〈 0. 05）. The best critical point of PSAD was 0. 27 ng·ml-1·cm-3 with a sensitivity and specificity degree of 83. 6% and 48. 2% respectively,and the positive and negative predictive value were 47. 0% and 84. 2% respectively. The multivariate Logistic regression analysis showed that high PSAD was the risk factor of capsular invasion of prostate cancer 〔OR = 4. 639,95% CI（ 1. 303,16. 514）, P = 0. 018 ）.Conclusion There is certain accuracy of PSAD in predicting capsular invasion of prostate cancer,which has certain clinical application value.

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 包膜侵犯 

分 类 号：R737.25[医药卫生—肿瘤]