fPSA/tPSA预测前列腺癌术后Gleason评分升高的临床价值  

Clinical value of fPSA/tPSA in predicting the Gleason score upgrading after radical prostatectomy

作　　者：李连红[1] 李冬阳[2] 宋武[1] 顾朝辉[1] 袁海川[1] 罗程鹏 

机构地区：[1]复旦大学附属华山医院宝山分院泌尿外科,上海200431 [2]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《现代泌尿外科杂志》2016年第8期580-584,共5页Journal of Modern Urology

摘　　要：目的分析前列腺癌患者术前血清游离前列腺特异性抗原(fPSA)与血清总前列腺特异性抗原(tPSA)的比值(fPSA/tPSA)预测根治术后Gleason评分(GS)升高的临床价值。方法对180例前列腺癌根治术后的患者临床资料进行回顾性分析,将根治术前后GS变化与患者年龄、术前GS、术前tPSA、术前fPSA、术前fPSA/tPSA、穿刺与根治术的间隔时间的相关性进行分析,并进一步分析术前GS=6分及GS≥7分的患者中评分升高与上述因素的关系。结果 180例患者经直肠超声(TURS)引导下经会阴穿刺活检GS与前列腺癌根治术后GS保持一致的104例(58.0%),GS下降的18例(10%),GS升高的58例(32%)。术前fPSA/tPSA与术后GS升高明显负相关(P=0.00);发现术后GS下降与年龄、术前tPSA、术前fPSA、术前fPSA/tPSA、穿刺与根治术的间隔时间无相关性。进一步应用受试者工作特征(ROC)曲线分析得出:经直肠超声引导下经会阴穿刺活检GS=6分的患者,当术前fPSA/tPSA<0.091 3提示根治术后GS升高可能性较大;穿刺活检GS≥7分的患者,当术前fPSA/tPSA<0.071 4提示根治术后GS升高可能性较大。结论术前fPSA/tPSA可作为预测前列腺癌术后GS升高的临床指标:术前fPSA/tPSA越低,提示术后GS升高的可能性越大。Objective To investigate the clinical value of the ratio of free prostate-specific-antigen （fPSA） and total prostate-specific-antigen （tPSA） （fPSA/tPSA） in predicting the Gleason score （GS） upgrading after radical prostatectomy in patients with prostate cancer. Methods Medical records of 180 patients who underwent radical prostatectomy were retro- spectively analyzed. The association between GS changes and patients＇ age, preoperative GS, tPSA, fPSA, fPSA/tPSA, and the time from biopsy to radical prostatectomy were analyzed. Factors that influenced the upgrading in patients with preopera- tive GS=6 and GS^7 were assessed. Results No difference in GS was noted in 104 cases （58%）, while a downgrade was noted in 18 cases （10%） and upgrade in 58 cases （32%）. Preoperative fPSA/tPSA （P=0） was negatively correlated with post- operative GS upgrading. There was no significant correlation between GS downgrading and age, preoperative tPSA, fPSA, fP- SA/tPSA, and the time from biopsy to radical prostatectomy. Further ROC curve analysis showed that for patients with GS= 6, preoperative fPSA/tPSA〈0. 091 3 associated with high possibility of postoperative GS upgrading;for patients with GS≥7, preoperative fPSA/tPSA〈0.071 4 associated with high possibility of postoperative GS upgrading. Conclusion Preoperative fPSA/tPSA may be a clinical predictor of the GS upgrading after radical prostatectomy： lower preoperative fPSA/tPSA may suggest greater possibility of GS upgrading.

关 键 词：前列腺癌 FPSA/TPSA Gleason评分升高 

分 类 号：R737.25[医药卫生—肿瘤]