不同ISUP分组初诊前列腺癌患者血清标志物与发生骨转移的相关性  

The relationship between the serum markers and bone metastasis of initial diagnosed prostate cancer patients in different ISUP groups

作　　者：韩跃辅 温星桥[2] 陈东 肖兆铭 李军[4] 冷区 温粤辉 祝炜安 Han Yuefu;Wen Xingqiao;Chen Dong;Xiao Zhaoming;Li Jun;Leng Qu;Wen Yuehui;Zhu Weian(Department of Urology,Yuebei People Hospital Affiliated to Medical College of Shantou University,Shaoguan 512026,China;department of Zhujiang Hospital Southern Medical University,Guangzhou 510282,China;Departmentof Urology,Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Urology,Nangfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Urology,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China)

机构地区：[1]汕头大学医学院附属粤北人民医院泌尿外科,韶关512026 [2]中山大学附属第三医院泌尿外科,广州510630 [3]南方医科大学南方医院泌尿外科,广州510515 [4]南方医科大学珠江医院泌尿外科,广州510282

出　　处：《中华泌尿外科杂志》2022年第6期441-446,共6页Chinese Journal of Urology

基　　金：国家自然科学基金(81874095)。

摘　　要：目的探讨不同国际泌尿外科病理协会(ISUP)分组的初诊前列腺癌患者血清碱性磷酸酶(ALP)和前列腺特异性抗原(PSA)与发生骨转移的相关性。方法回顾性分析2013年1月至2018年12月收治的368例初诊前列腺癌患者的病例资料,中山大学附属第三医院247例,汕头大学医学院附属粤北人民医院111例,南方医科大学深圳医院10例。根据初诊时是否伴有骨转移分为骨转移组230例和无骨转移组138例,两组的年龄[(71.9±9.4)岁与(71.2±8.7)岁]、体质指数(BMI)[(23.1±3.7)kg/m^(2)与(23.7±2.6)kg/m^(2)]差异无统计学意义(P>0.05),PSA[(307.3±847.0)ng/ml与(84.5±257.3)ng/ml]、血清碱性磷酸酶(ALP)[(174.5±270.8)U/L与(71.0±23.2)U/L]差异有统计学意义(P<0.05)。368例中,PSA<10 ng/ml 45例、10~20 ng/ml 35例、>20 ng/ml 288例。根据不同ISUP分组,比较骨转移组与无骨转移组的ALP、PSA差异。采用受试者工作特征(ROC)曲线分析ALP、PSA预测发生骨转移的效能。结果骨转移组和无骨转移组ISUP 1~5组分别为3例(1.3%)和14例(10.1%)、22例(9.6%)和19例(13.8%)、34例(14.8%)和29例(21.0%)、85例(37.0%)和32例(23.2%)、86例(37.4%)例和44例(31.9%)。骨转移组和无骨转移组中,ISUP 4组[(157.6±207.7)U/L与(66.5±17.0)U/L]和5组[(189.4±257.5)U/L与(69.2±18.4)U/L]的血清ALP比较差异均有统计学意义(P<0.001);ISUP 3组[(240.3±313.0)ng/ml与(42.4±42.1)ng/ml]、4组[(152.3±184.5)ng/ml与(44.7±33.3)ng/ml]、5组[(435.2±1006.3)ng/ml与(60.8±84.8)ng/ml]的血清PSA比较差异均有统计学意义(P<0.001)。骨转移组和无骨转移组中,PSA>20 ng/ml亚组的PSA值[(336.1±882.2)ng/ml与(139.3±328.1)ng/ml]差异有统计学意义(P=0.006)。ROC曲线分析结果显示,在ISUP 2~5组中,血清ALP预测骨转移的临界值分别为115.5、109.0、75.5、86.0 U/L,敏感性分别为23.8%、56.5%、66.4%、50.6%,特异性分别为99.7%、93.4%、78.3%、89.2%,准确性分别为59.4%、73.1%、69.7%、63.3%;血清PSA预测骨转移的临界�Objective To investigate the relationship between the serum alkaline phosphatase(ALP),prostate specific antigen(PSA)and bone metastasis in initially diagnosed prostate cancer(PCa)patients in different ISUP(International Society of Urological Pathology)groups.Methods The 368 initial diagnosed prostate cancer patients recruited from January 2013 to December 2018 were retrospectively analyzed,including 247 cases in the Third Affiliated Hospital of Sun Yat-sen University,111 cases in the Yuebei People's Hospital Affiliated to Medical College of Shantou University and 10 cases in Shenzhen Hospital of Southern Medical University.According to whether there was bone metastasis at the initial diagnosis,it was divided into 230 cases in the bone metastasis group and 138 cases in the non bone metastasis group.There was no significant difference between the two groups in age[(71.9±9.4)years and(71.2±8.7)years],body mass index(BMI)[(23.1±3.7)kg/m^(2) and(23.7±2.6)kg/m^(2)].There were significant differences in PSA[(307.3±847.0)ng/ml and(84.5±257.3)ng/ml]and ALP[(174.5±270.8)U/L and(71.0±23.2)U/L]between the two groups.In different PSA subgroups,there were 45 cases in PSA<10 ng/ml,35 cases in PSA 10-20 ng/ml and 288 cases in PSA>20 ng/ml.The differences of ALP and PSA between bone metastasis group and non-bone metastasis group based on different ISUP stratification were analyzed,ROC curves were used to predict their risks of bone metastasis.Results There were 3(1.3%),22(9.6%),34(14.8%),85(37.0%)and 86(37.4%)prostate cancer patients with bone metastasis from ISUP group 1 to 5,and 14(10.1%),19(13.8%),29(21.0%),32(23.2%)and 44(31.9%)without bone metastasis,respectively.There was significant difference in the serum ALP levels between the bone metastasis group and the boneless metastasis group in the ISUP group 4(157.6±207.7 vs.66.5±17.0)and 5(189.4±257.5 vs.69.2±18.4)(P<0.001)and PSA levels had difference in the ISUP group 3(240.3±313.0 vs.42.4±42.1),4(152.3±184.5 vs.44.7±33.3)and 5(435.2±1006.3 vs.60.8±84.8)(P<0.

关 键 词：前列腺肿瘤 前列腺癌 骨转移 碱性磷酸酶 前列腺特异性抗原 国际泌尿外科病理协会 

分 类 号：R737.25[医药卫生—肿瘤]