基于超声造影建立列线图预测前列腺癌治疗后生化复发的价值  

The value of a nomogram based on contrast-enhanced ultrasound for the prediction of biochemical recurrence of prostate cancer after treatment

作　　者：辛艳芬 闫珊玲[2] 周柱玉[2] 文元[3] 郑红[2] 蒲英梅[2] 李明星[1] XIN Yan-fen;YAN Shan-ling;ZHOU Zhu-yu(Department of Ultrasound,the Affiliated Hospital of Southwest Medical University,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院超声医学科,四川646000 [2]四川省德阳市人民医院超声医学科,四川618000 [3]四川省德阳市人民医院检验科,四川618000

出　　处：《放射学实践》2021年第9期1152-1157,共6页Radiologic Practice

基　　金：德阳市科技局重点科技计划(NO.2018SZS063)。

摘　　要：目的:探讨基于超声造影参数联合常见影响因素建立列线图预测前列腺癌(PCa)治疗后生化复发的价值。方法:选择PCa患者149例,治疗前均接受前列腺特异性抗原(PSA)水平的测定、超声造影以及穿刺活检病理分级,治疗后进行5年随访。随访期间出现生化复发的PCa患者纳入复发组,其余患者纳入未复发组。比较复发组与未复发组的临床指标及超声造影参数的差异。采用多因素COX回归筛选影响PCa患者生化复发的独立影响因素,并建立列线图预测PCa患者生化复发的概率。结果:149例患者中,失访8例,余141例患者治疗后5年内生化复发率为29.1%,41例纳入复发组,100例纳入未复发组。多因素COX回归分析结果显示淋巴结转移(P=0.032)、治疗方式(P=0.035)、Gleason评分(P=0.031)、治疗前PSA(P=0.022)、峰值强度(PI)(P=0.048)及达峰时间(TTP)(P=0.041)是PCa治疗后生化复发的独立影响因子。基于上述因子建立的列线图具有良好的区分度(C-index 0.935)和校准度(χ2=9.514,P=0.301,Hosmer-Lemeshow检验),能够准确预测PCa患者生化复发的风险。结论:基于超声造影结合常见影响因素建立的列线图可以精确预测PCa患者治疗后生化复发的概率,有助于临床及时采取预防措施以改善患者预后。Objective:To explore the value of establishing a nomogram based on contrast-enhanced ultrasound(CEUS)indicators combined with common influencing factors in predicting biochemical recurrence of prostate cancer(PCa)after treatment.Methods:A total of 149 patients with PCa were enrolled and underwent prostate-specific antigen(PSA)measurement,CEUS and pathological classification after puncture biopsy.A 5-year follow-up was carried out after treatment.PCa patients with biochemical recurrence during follow-up were included in the recurrence group,and the remaining patients in the non-recurrence group.The differences in clinical indicators and CEUS parameters between the recurrence group and non-recurrence group were compared.Multivariate COX regression was used to screen independent factors influencing biochemical recurrence in PCa patients,and a nomogram was established to predict the probability of biochemical recurrence in PCa patients.Results:Of the 149 patients,eight cases were lost to follow up,and the biochemical recurrence rate of the remaining 141 patients was 29.1%within 5 years after treatment.41 patients were included in the recurrence group and 100 in the non-recurrence group.Multivariate COX regression showed that lymph node metastasis(P=0.032),treatment modality(P=0.035),Gleason score(P=0.031),pretreatment PSA(P=0.022),peak intensity(PI)(P=0.048)and time to peak(TTP)(P=0.041)were independent factors influencing biochemical recurrence after PCa treatment.The nomogram based on the above factors showed good discrimination(C-index 0.935)and calibration(χ2=9.514,P=0.301,Hosmer-Lemeshow test),which could accurately predict the risk of biochemical recurrence in PCa patients.Conclusion:The nomogram based on CEUS combined with common influencing factors can accurately predict the probability of biochemical recurrence in PCa patients after treatment,which is helpful for the clinical practice to take timely preventive measures to improve patient prognosis.

关 键 词：前列腺癌 生化复发 列线图 超声造影 时间-强度曲线 预测 

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