基于2014ISUP分组预测根治性前列腺切除术后病理升级的列线图的建立与内部验证  

Nomogram for predicting Gleason grouping upgrading(GGU)in a cohort receiving radical prostatectomy based on 2014 ISUP grouping system:development and internal validation

作　　者：刘奥 黄海[1] 张传杰 黄静怡 徐阳[1,2] 黄答 那溶 陈露 高轶 徐丹枫 Liu Ao;Huang Hai;Zhang Chuanjie;Huang Jingyi;Xu Yang;Huang Da;Na Rong;Chen Lu;Gao Yi;Xu Danfeng(Department of Urology Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine Shanghai 200025,China;Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,上海200025 [2]上海交通大学医学院,200025

出　　处：《中华泌尿外科杂志》2020年第4期297-302,共6页Chinese Journal of Urology

摘　　要：目的基于2014年国际泌尿病理协会(ISUP)分组构建预测根治性前列腺切除术(RP)后标本较穿刺标本Gleason分组升级(GGU)的列线图,并进行内部验证。方法回顾性分析上海瑞金医院2012年3月至2019年3月收治的429例因前列腺癌行RP患者的临床病理资料。年龄(68.1±7.2)岁。体质指数(BMI)(24.2±3.2)kg/m^2。前列腺特异性抗原(PSA)11.5(6.7~20.4)ng/ml,PSA密度(PSAD)0.35(0.20~0.66)。2017年3月以前患者为6~8针穿刺,之后均为12针穿刺。429例均行RP。比较穿刺病理与根治术后病理的2014 ISUP分组差异。采用logistic回归分析预测GGU的独立影响因素,依据多因素分析结果建立预测GGU的列线图并评估其预测效能。结果本研究429例,RP术后GGU组161例(37.5%),非GGU组268例(62.5%)。多因素logistic回归分析结果显示,BMI>28 kg/m^2(OR=2.54,P=0.030)、PSAD(OR=1.65,P=0.015)、术前2014 ISUP分组(OR=0.53,P<0.001)为GGU的独立影响因素。以BMI、PSAD及术前2014 ISUP分组建立预测GGU的列线图,预测模型受试者工作特征曲线下面积为0.735(95%CI 0.681~0.789),模型经过良好校准,平均绝对误差为6.7%,模型在预测RP术后病理升级方面与实际情况有较好一致性。结论BMI>28 kg/m^2、PSAD及术前2014 ISUP分组为前列腺癌患者RP术后GGU的独立影响因素,基于上述指标建立的预测GGU的列线图具有较好的预测效能。Objective To analyze the predictive factors of GGU between biopsy and radical prostatectomy pathology based on 2014 ISUP grouping system,then establish and evaluate nomogram.Methods Patients undergoing radical prostatectomy in Shanghai Ruijin Hospital from March 2012 to March 2019 were reviewed,and the clinical and pathological information were collected.Age(68.1±7.2),body mass indes(BMI)(24.2±3.2)kg/m^2,prostate specific antigen(PSA)11.5(6.7-20.4)ng/ml,prostate specific antigen destiny(PSAD)0.35(0.20-0.66).Before March 2017,the number of biopsy cores were 6 to 8;After then,all patients toke 12 cores systemic biopsy.Based on 2014 ISUP grouping system,the differences between biopsy and radical prostatectomy grades were counted.The independent predictors of GGU were analyzed by univariate and multivariate logistic regression analysis,then the nomogram for predicting GGU were established and evaluated.Results 429 patients were enrolled.There were 161(37.5%)patients in GGU group and 268(62.5%)patients in non-GGU group.After multivariate logistic regression analysis,body mass index(BMI)>28 kg/m^2(OR=2.54,P=0.021),prostate specific antigen density(PSAD)(OR=1.65,P=0.018)and 2014 ISUP grouping sysyem(OR=0.53,P<0.001)of biopsy specimen were independent impact factors of GGU.The predicting model was established according to BMI,PSAD and 2014 ISUP grouping system.The area under the ROC cure of the model was 0.735(95%CI 0.681-0.789).The nomogram model was well calibrated,with the mean absolute error of 6.7%,which means the prediction of GGU is fairly consistent with the actual situation.Conclusions Based on the 2014 ISUP grouping system,BMI>28 kg/m^2,PSAD and 2014 ISUP grouping of biopsy specimen were independent predictors of GGU.The nomogram model for predicting GGU has a good statistical significance.

关 键 词：前列腺肿瘤 GLEASON评分 2014年国际泌尿病理协会分组 活检 手术标本 病理升级 

分 类 号：R737[医药卫生—肿瘤]