临床评分系统预测前列腺癌根治术后生化复发的价值  

Clinical Scoring System Predicts the Value of Biochemical Recurrence after Radical Prostatectomy

作　　者：黄鹏 廖鑫鑫 陆文宝 张良[1] 周海滨 黄玉清 蔡军 曾泉 HUANG Peng;LIAO Xin-xin;LU Wen-bao;ZHANG Liang;ZHOU Hai-bin;HUANG Yu-qing;CAI Jun;ZENG Quan(Department of Urology,the Affiliated Hospital of Jiujiang University,Jiujiang 332000,Jiangxi,China;Department of Urology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China)

机构地区：[1]九江学院附属医院泌尿外科,江西九江332000 [2]南昌大学第二附属医院泌尿外科,江西南昌330006

出　　处：《医学信息》2020年第8期76-79,共4页Journal of Medical Information

摘　　要：目的建立临床评分模型(CSM)评估前列腺癌根治术后生化复发(BCR)的风险。方法收集2001年7月~2013年1月在九江学院附属医院和南昌大学第二附属医院泌尿外科接受根治性前列腺切除术(RP)的患者528例,收集患者一般资料和手术资料,包括年龄、治疗前血清tPSA、活检Gleason评分、血清总睾酮、手术切缘状态、包膜侵犯、精囊腺侵犯和淋巴结转移等;Logistic回归分析前列腺癌根治术后BCR的危险因素,利用危险因素建立CSM预测患者术后5年内BCR的风险,并将其分为低风险、中等风险和高风险组,ROC曲线评估CSM的有效性。结果RP术后患者平均随访时间为(56.77±26.64)个月。多因素Logistic回归分析显示:tPSA(HR=2.312,95%CI:1.624~3.285)、Gleason评分(HR=2.761,95%CI:1.925~4.276)、包膜侵犯(HR=1.925,95%CI:1.235~3.517),手术切缘阳性(HR=2.235,95%CI:1.684~3.927),精囊腺侵犯(HR=2.032,95%CI:1.528~3.529)和淋巴结转移(HR=2.586,95%CI:1.624~4.351)是患者术后BCR的危险因素。低风险、中等风险和高风险组患者术后BCR发生率比较,差异有统计学意义(P<0.05);ROC曲线显示,CSM的曲线下面积为0.7882,当截断值为10.5分时,CSM的敏感性和特异性分别为77.08%、69.83%,可预测RP后5年内BCR的风险(P<0.05)。结论CSM可预测前列腺癌患者前列腺癌根治术后BCR的风险,当患者的CSM较高时,术后早期干预可能会降低其BCR风险。Objective To establish a clinical scoring model(CSM)to assess the risk of biochemical recurrence(BCR)after radical prostatectomy.Methods A total of 528 patients who underwent radical prostatectomy(RP)in the urology department of the Affiliated Hospital of Jiujiang University and the Second Affiliated Hospital of Nanchang University from July 2001 to January 2013 were collected,and the general and surgical data of the patients were collected,including age and treatment Pre-serum tPSA,biopsy Gleason score,serum total testosterone,surgical margin status,capsular invasion,seminal vesicle invasion,and lymph node metastasis;Logistic regression analysis of risk factors for BCR after radical prostatectomy,using risk factors to establish CSM to predict the risk of BCR within 5 years after surgery,and divide it into low-risk,medium-risk,and high-risk groups,ROC curve to evaluate the effectiveness of CSM.Results The average follow-up time of patients after RP was(56.77±26.64)months.Multivariate Logistic regression analysis showed that:tPSA(HR=2.312,95%CI:1.624~3.285),Gleason score(HR=2.761,95%CI:1.925~4.276),capsule invasion(HR=1.925,95%CI:1.235~3.517),positive surgical margin(HR=2.235,95%CI:1.684~3.927),seminal vesicle invasion(HR=2.032,95%CI:1.528~3.529)and lymph node metastasis(HR=2.586,95%CI:1.624~4.351)is a risk factor for postoperative BCR.The incidence of postoperative BCR in the lowrisk,medium-risk,and high-risk groups was statistically significant(P<0.05);the ROC curve showed that the area under the CSM curve was 0.7882.When the cutoff value was 10.5,the CSM’s sensitivity and specificity were 77.08%and 69.83%,respectively,which can predict the risk of BCR within 5 years after RP(P<0.05).Conclusion CSM can predict the risk of BCR after radical prostatectomy in patients with prostate cancer.When the CSM of patients is high,early postoperative intervention may reduce their BCR risk.

关 键 词：前列腺癌 临床评分模型 生化复发 根治性前列腺切除术 

分 类 号：R73[医药卫生—肿瘤]