前列腺穿刺活检与根治手术后病理分级相符性研究及预测模型的建立  

Consistency of prostate biopsy and radical prostatectomy Gleason grade groups and nomograms establishment for predicting upgrading and downgrading

作　　者：郑祥义[1] 颜华卿 何柳佳 项尖尖[2] 滕晓东[3] 谢立平[1] Zheng Xiangyi;Yan Huaqing;He Liujia;Xiang Jianjian;Teng Xiaodong;Xie Liping(Department of Urology,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Ultrasound,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Pathology,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]浙江大学医学院附属第一医院超声科,杭州310003 [3]浙江大学医学院附属第一医院病理科,杭州310003

出　　处：《中华泌尿外科杂志》2019年第9期668-672,共5页Chinese Journal of Urology

基　　金：国家自然科学基金面上项目(81772744).

摘　　要：目的探讨前列腺穿刺活检与根治手术后病理分级的相符性,分析可能导致病理分级变化的影响因素,并建立预测模型.方法回顾性分析2013年1月至2018年12月浙江大学医学院附属第一医院收治的670例前列腺癌患者的临床资料.中位年龄67岁(35 ~ 100岁).体质指数中位值23.74 kg/m^2(16.22 ~ 38.74 kg/m^2).tPSA中位值10.266 ng/ml(0.017~147.575 ng/ml).前列腺体积中位值29.43 ml(5.92~ 187.20 ml).PSAD中位值0.34(0.01 ~4.02).穿刺阳性针数比例中位值0.25(0.08 ~ 1.00).临床分期≤T1c期161例,T2a~ T2c期344例,≥T3期165例.根据前列腺穿刺活检病理分级分组(GR)将患者分为GR1组(Gleason评分3+3=6分)330例,GR2组(3+4=7分)340例.670例均行根治性前列腺切除术.记录前列腺穿刺活检与根治手术后病理分级的相符性.根治手术病理分级高于前列腺穿刺活检病理分级定义为病理分级上调,反之定义为下调.采用多因素logistic回归模型分析导致GR1组病理分级上调或GR2组病理分级下调的影响因素.基于logistic回归模型绘制列线图,并以曲线下面积和霍斯默-莱梅肖检验验证列线图的区分度和一致性.结果本研究670例中,GR1组病理分级上调165例(50.0%),GR2组病理分级下调27例(7.9%).患者PSAD ≥0.25(OR=3.015)及临床分期≥T2b期(OR=7.185)是GR1组病理分级上调的独立影响因素.患者PSAD <0.15(OR =4.208)、临床分期≤T1c期(OR =4.530)是GR2组病理分级下调的独立影响因素.列线图的曲线下面积(GR1组0.781,GR2组0.741)和霍斯默-莱梅肖检验结果(GR1组P=0.993,GR2组P=0.234)显示该列线图有良好的区分度和一致性.结论患者PSAD及临床分期是前列腺穿刺活检病理分级上调或下调的独立影响因素.本研究绘制的列线图可为临床医师判断患者穿刺活检病理分级的准确性提供一定参考,但具体效果仍需临床实践验证.Objective To evaluate the consistency between prostate biopsy and postoperative pathological grade, analyze the influencing factors that may lead to upgrade or downgrade, and to establish a prediction model. Methods The clinical data of biopsy GS3+ 3=6(GR1, 330 cases) and GS3+ 4=7(GR2, 340 cases) patients from January 2013 to December 2018 in the first affiliated hospital, College of Medicine of Zhejiang university were retrospectively analyzed. The median age was 67 years old(ranging 35 to 100 years old). The median BMI was 23.74 kg/m^2(ranging 16.22-38.74 kg/m^2). The Median tPSA was 10.266 ng/ml(ranging 0.017-147.575 ng/ml). The median prostate volume was 29.43 ml(5.92-187.20 ml). The median PSAD was 0.34 (ranging 0.01-4.02). The median percentage of positive puncture cores was 0.25 (ranging 0.08-1.00). There were 161 patients in clinical stage ≤T1c, 344 patients in T2a-T2c and 165 patients in clinical stage ≥T3. 670 cases all accepted the radical prostatectomy. Consistency of prostate biopsy and radical prostatectomy Gleason grade was recorded. If the postoperative Gleason grade was higher than that in biopsy, it was defined as upgrade. Otherwise, it was defined as downgrade. Multivariate logistic regression model was used to evaluate the influencing factors leading to upgrades in GR1 patients or downgrades in GR2 patients. Nomograms were drawn based on the models with AUC and Horsmer-Lemeshaw test conducted to test the discrimination and calibration of the models. Results Among the 670 patients included, 165 cases (50.0% of GR1) upgrades and 27 cases (7.9% of GR2) downgrades. PSAD≥0.25(OR=3.015) and clinical stage≥T2b(OR=7.185)were independent influencing factors for the upgrade in GR1 patients, while PSAD<0.15(OR=4.208) and clinical stage≤T1c(OR=4.530) were independent influencing factors for downgrade. The nomograms were drawn with the above variables. The AUC of the model (0.781 for GR1 group, 0.741 for GR2 group) and the hosmer-remeshaw test results (P=0.993 for GR1 group, P=0.234 for GR2 group

关 键 词：前列腺肿瘤 GLEASON评分 前列腺穿刺 根治性前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]