术前低PSA的Gleason 8~10分前列腺癌患者临床特点  

Clinical features of prostate cancer patients with Gleason score 8-10 and low preoperative PSA level

作　　者：徐耀宗 顾晓[2] 王飞 栾阳[2] 卢圣铭[2] 黄天宝[2] 丁雪飞[2] XU Yaozong;GU Xiao;WANG Fei;LUAN Yang;LU Shengming;HUANG Tianbao;DING Xuefei(Graduate School of Dalian Medical University,Dalian 116044,Liaoning Province,China;Department of Urology,Subei People’s Hospital of Jiangsu Province,Yangzhou 225001,Jiangsu Province,China)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]江苏省苏北人民医院泌尿外科,江苏扬州225001

出　　处：《中国癌症杂志》2020年第5期383-387,共5页China Oncology

摘　　要：背景与目的:前列腺癌的发病率逐渐上升,其中有些患者在诊断为高级别前列腺癌甚至转移性前列腺癌时,其前列腺特异性抗原(prostate-specific antigen,PSA)数值却处于很低的水平。探讨术前低血清PSA的Gleason 8~10分前列腺癌患者临床特点。方法:收集2013年1月-2018年1月江苏省苏北人民医院收治的72例接受前列腺癌根治术的高Gleason评分前列腺癌患者的临床资料。根据术前血清PSA水平分为4组:A组<4.0 ng/mL(9例)、B组4.0~10.0 ng/mL(12例)、C组10.0~20.0 ng/mL(15例)和D组>20.0 ng/mL(36例)。4组平均年龄分别为(68.8±8.6)、(68.9±6.0)、(71.6±6.0)和(68.4±6.4)岁。平均随访时间分别为(21.6±12.1)、(18.8±7.2)、(25.0±13.4)和(24.8±12.5)个月。切缘阳性例数分别为3例(33.3%)、5例(41.7%)、5例(33.0%)和15例(41.7%)。精囊侵犯例数分别为6例(66.7%)、2例(16.7%)、2例(13.3%)和14例(38.9%)。淋巴结转移例数分别为2例(22.2%)、3例(25.0%)、4例(26.7%)和13例(36.1%)。预后评价指标为无生化复发天数(biochemical progression-free day,bPFD)与前列腺癌特异性死亡(prostate cancer-specific death,PCSD)。4组平均PFD分别为(90.00±38.40)、(306.17±79.00)、(223.14±63.30)和(145.03±62.50)d。PCSD例数分别为4例(44.4%)、0例(0.0%)、1例(6.7%)和5例(13.9%)。组间年龄、随访时间、PFD使用单因素方差分析,进一步两两比较采用最小显著差别(least significant difference,LSD)法;组间临床病理学特征采用χ2检验、Fisher精确检验;PCSD使用Kaplan-Meier生存分析,生存曲线间比较使用log-rank检验。结果:A组与其余3组相比,年龄、随访时间、切缘阳性、淋巴结转移的差异均无统计学意义(P>0.05)。A组与B、C两组相比,精囊侵犯、PFD的差异均有统计学意义(P<0.05)。但A组与D组相比,精囊侵犯、PFD的差异无统计学意义(P>0.05)。生存分析显示,A组相较于B组在随访时间内生存状况更差,但差异无统计学意义(P=0.092),A组与C、DBackground and purpose: The incidence of prostate cancer is on the rise, and some of these cases have low prostate-specific antigen(PSA) levels even when they are diagnosed with advanced or metastatic prostate cancer. This study aimed to investigate the outcome in patients with Gleason score 8-10 prostate cancer and low preoperative PSA level. Methods: Clinical data of 72 cases of high-grade prostate cancer receiving radical prostatectomy in Subei People’s Hospital of Jiangsu Province from Jan. 2013 to Jan. 2018 were collected. Based on the preoperative PSA level, the patients were divided into four groups: group A [<4.0 ng/mL(9 cases)], group B [4.0-10.0 ng/mL(12 cases)], group C [10.0-20.0 ng/mL(15 cases)] and group D [>20.0 ng/mL(36 cases)]. In the group A, B, C and D, the mean age was(68.8±8.6),(68.9±6.0),(71.6±6.0) and(68.4±6.4)years, while the mean follow-up time was(21.6±12.1),(18.8±7.2),(25.0±13.4) and(24.8±12.5) months respectively. The cases with positive margin were 3(33.3%), 5(41.7%), 5(33.3%) and 15(41.7%). The cases with seminal vesicle invasion were 6(66.7%), 2(16.7%), 2(13.3%) and 14(38.9%). The cases with lymph node metastasis were 2(22.2%), 3(25.0%), 4(26.7%) and 13(36.1%). The prognostic measures were biochemical progression-free day(bPFD) and prostate cancer-specific death(PCSD). The mean PFD was(90.00±38.40),(306.17±79.00),(223.14±63.30) and(145.03±62.50) d in the four groups. The number of PCSD was 4(44.4%), 0(0.0%), 1(6.7%) and 5(13.9%). Age, follow-up time and PFD among groups were analyzed by single factor variance analysis, and least significant difference(LSD) method was used for further pairwise comparison. Clinical and pathological features were analyzed by χ2 and Fishers exact test. PCSD was analyzed by Kaplan-Meier survival analysis, and comparison between survival curves was analyzed by log-rank test. Results: There was no significant difference in age, followup time, positive margin and lymph node metastasis between group A and the other three groups(P>0.05). There

关 键 词：前列腺癌 前列腺特异性抗原 GLEASON评分 癌症预后 

分 类 号：R737.25[医药卫生—肿瘤]