超声造影早期预测前列腺癌经内分泌治疗后进展为去势抵抗性前列腺癌的价值  

Value of contrast-enhanced ultrasound in early predicting the progression of castration-resistant prostate cancer after endocrine therapy in patients with prostate cancer

作　　者：刘靖[1] 陈珂 刘菊[1] 李琳[1] LIU Jing;Chen Ke;LIU Ju(Department of General Medical(Department of Geriatrics),Wuhan NO.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院综合医疗科(老年病科),武汉430022 [2]武汉市第三医院超声影像科,武汉430060

出　　处：《放射学实践》2021年第9期1127-1132,共6页Radiologic Practice

摘　　要：目的:探讨超声造影(CEUS)联合常见影响因素早期预测前列腺癌(PCa)患者经内分泌治疗后2年内进展为去势抵抗性前列腺癌(CRPC)的价值。方法:选择接受内分泌治疗的92例中晚期PCa患者作为研究对象,治疗前均接受前列腺特异抗原(PSA)水平测定、CEUS检查以及病理分级。内分泌治疗后进行2年随访,随访期间进展为CRPC的PCa患者纳入预后不良组,其余患者纳入预后良好组。比较两组患者的临床指标及CEUS参数,并利用多因素COX回归进行筛选,获得PCa患者进展为CRPC的影响因素。利用受试者工作特征(ROC)曲线评估潜在影响因素早期预测CRPC的价值,并分析各影响因素的联合模型早期预测CRPC的准确性。结果:2年随访期内CRPC的发生率为63.04%(58/92)。多因素COX回归分析结果显示,T分期(P=0.021)、M分期(P=0.024)、Gleason评分(P=0.018)、治疗前PSA(P=0.004)、AUC TIC(P=0.003)是影响PCa进展为CRPC的独立影响因素。ROC曲线分析结果显示各指标预测CRPC的准确性均不高(AUC均<0.9),其中AUC TIC的准确性最高(AUC=0.818)。T分期、M分期、Gleason评分、治疗前PSA的联合可以提高早期预测CRPC的准确性,但准确性仍然不够高(AUC=0.834<0.9)。结合AUC TIC的联合预测模型能够在早期准确预测PCa患者进展为CRPC的概率(AUC=0.910),拟合方程为Logit(P)=-1.259+0.667×M分期+0.420×T分期+0.164×Gleason评分+0.021×治疗前PSA+0.007×AUC TIC。结论:Gleason评分、T分期、M期、治疗前PSA以及AUC TIC是早期预测老年PCa患者进展为CRPC的独立影响因素,利用超声造影指标AUC TIC结合常规临床指标建立的预测模型可以早期准确预测PCa患者进展为CRPC的概率。Objective:To explore the value of contrast-enhanced ultrasound(CEUS)combined with common influencing factors in predicting the progression of castration-resistant prostate cancer(CRPC)within 2 years after endocrine therapy in patients with prostate cancer(PCa).Methods:Ninety-two patients with advanced PCa and treated with endocrine therapy were enrolled.The prostate specific antigen(PSA)measurement,CEUS examination,and pathological grading assessment were conducted before treatment.Patients were followed for two years,and classified into poor prognosis group if progressed to CRPC,while the remaining patients were classified into good prognosis group.The clinical indicators and CEUS parameters of two groups were compared Multivariate COX regression was used to obtain the factors that affect the progression of CRPC.The receiver operating characteristic(ROC)curves were used to assess the value of influencing factors in early prediction of CRPC,and the accuracy of the early prediction of CRPC in a combined model of various influencing factors was also explored.Results:The incidence of CRPC in this study was 63.04%during the 2-year follow-up.Multivariate COX regression showed that T stage(P=0.021),M stage(P=0.024),Gleason score(P=0.018),PSA before treatment(P=0.004),AUC TIC(P=0.003)were independent influencing factors of CRPC.ROC results showed that the accuracy of each parameter predicting CRPC is not high(all AUC<0.9),but the accuracy of AUC TIC was the highest(AUC=0.818).The combination of T staging,M staging,Gleason score,and PSA before treatment could improve the accuracy of the early prediction of CRPC,but it was still not accurate enough(AUC=0.834,<0.9).The combined prediction model including AUC TIC could accurately predict the probability of disease progression to CRPC(AUC=0.910),with fitting equation of Logit(P)=-1.259+0.667×M staging+0.420×T staging+0.164×Gleason score+0.021×PSA before treatment+0.007×AUC TIC.Conclusion:Gleason score,T stage,M stage,PSA before treatment,and AUC TIC are independent risk

关 键 词：前列腺肿瘤 老年人 超声造影 内分泌治疗 去势抵抗性前列腺癌 

分 类 号：R737.25[医药卫生—肿瘤] R445.1[医药卫生—临床医学]