前列腺钙化灶、精索静脉曲张超声影像联合血清学指标列线图对前列腺癌的鉴别诊断价值  

Value of nomogram based on the ultrasonographic features of prostatic calcification and varicocele and serological indicators in differential diagnosis of prostate cancer

作　　者：谢迎东 孙帼 徐超丽 XIE Ying-dong;SUN Guo;XU Chao-li(Department of Ultrasonographic Diagnosis,General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China;Department of Ultrasound,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]东部战区总医院超声诊断科,江苏南京210002 [2]南京医科大学附属第一医院超声科,江苏南京210029

出　　处：《中华男科学杂志》2022年第7期596-602,共7页National Journal of Andrology

摘　　要：目的:探讨经腹部前列腺钙化灶、精索静脉曲张超声影像联合血清学指标对前列腺癌(PCa)伴良性前列腺增生(BPH)与单纯BPH的鉴别诊断价值。方法:回顾性分析2014年1月至2021年12月在东部战区总医院经术后病理确诊为PCa伴BPH的患者108例,确诊为单纯BPH的患者317例。t检验或χ^(2)/Fisher检验分析2组患者临床病理资料、经腹部超声特征及精索静脉曲张影像特征及血清学的差异。使用Logistic回归分析筛选出鉴别PCa伴BPH和单纯BPH的独立因素,并制作列线图可视化鉴别其诊断效能。结果:经腹部超声显示前列腺钙化灶分型、钙化直径占比、前列腺抗原密度(PSAD)、总PSA(tPSA)、精索静脉曲张程度、睾酮水平在PCa伴BPH和单纯BPH组间差异有统计学意义(P<0.05)。通过Logistic回归分析,前列腺钙化分型、PSAD和精索静脉曲张程度被确定为鉴别PCa伴BPH和单纯BPH的独立风险因素。基于列线图模型鉴别PCa伴BPH和单纯BPH的ROC曲线下面积为0.805,敏感性为83.28%,特异性为70.37%。结论:经腹部超声前列腺钙化灶分型、精索静脉曲张以及PSAD可能与PCa的发生发展存在一定相关性,基于以上特征构建列线图模型可作为一种无创性量化工具在一定程度上鉴别PCa伴BPH和单纯BPH。Objective:To explore the diagnostic performance of the nomogram based on the transabdominal ultrasonographic features of prostatic calcification and varicocele(VC)and serological indicators in differentiating PCa with BPH from simple BPH.Methods:This retrospective study included 108 cases of PCa with BPH and 317 cases of simple BPH,all pathologically confirmed after surgery from January 2014 to December 2021.Using t test orχ^(2)/Fisher test,we compared the clinicopathologic data,transabdominal ultrasonographic features of prostatic calcification,VC severity and serological indicators between the two groups of patients.We identified the significant independent factors for differentiating PCa with BPH from simple BPH by multivariate logistic regression analysis and constructed a nomogram for visualizing the differential diagnostic performance.Results:There were significant differences in the types and diameters of prostatic calcification,PSA density(PSAD),total PSA(tPSA),VC severity,and serum testosterone level between the two groups(P<0.05).The types of calcification,PSAD and VC severity were identified as independent factors for differentiating PCa with BPH from simple BPH.Nomogram analysis of the above factors showed a good predicting performance,with an AUC of 0.805,a sensitivity of 83.28%and a specificity of 70.37%.Conclusion:Transabdominal ultrasonographic features and types of prostatic calcification,PSAD and VC severity are correlated with the development and progression of PCa.Nomogram analysis of the above factors contributes to the differentiation of PCa with BPH from simple BPH.

关 键 词：前列腺癌 良性前列腺增生 前列腺钙化 超声 列线图 

分 类 号：R737.25[医药卫生—肿瘤]