局限性前列腺癌根治手术后Gleason分组升级的因素及预测模型的建立  

Influencing factor analysis and prediction model establishment of Gleason group upgrading after radical prostatectomy of localized prostate cancer

作　　者：李强 许长宝[1] 赵兴华[1] 李武学[1] 程沛[1] Li Qiang;Xu Changbao;Zhao Xinghua;Li Wuxue;Cheng Pei(Department of Urology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450000

出　　处：《中华泌尿外科杂志》2023年第10期761-766,共6页Chinese Journal of Urology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210430)。

摘　　要：目的基于2014年国际泌尿病理协会(ISUP)前列腺癌分级分组系统,探讨局限性前列腺癌患者根治性前列腺切除术(RP)后Gleason分组升级(CCU)的独立影响因素,建立列线图模型并验证。方法提取2010—2018年SEER数据库中接受RP的48567例局限性前列癌患者的病例资料。年龄(61.1±7.0)岁。白种人39014例(80.3%),黑种人7063例(14.5%),亚裔或太平洋岛民2331例(4.8%),美国印第安人或阿拉斯加原住民159例(0.3%)。前列腺特异性抗原(PSA)<4 ng/ml6545例(13.5%)、4~10ng/ml35007例(72.1%)、11~19 ng/ml5578例(11.5%)、≥20 ng/ml1437例(3.0%)。前列腺穿刺阳性针数比例(PPC)≥33%24743例(50.9%)。穿刺标本Cleason分组1组18971例(39.1%)2组18446例(38.0%)3组7093例(14.6%)、4组4057例(8.4%)。采用简单随机抽样的方法,按7:3比例将患者分为训练组和内部验证组。收集2017年1月至2021年12月郑州大学第二附属医院接受RP的67例局限性前列癌患者作为外部验证组。年龄(66.4±10.3)岁。患者均为中国籍黄种人。PSA<4ng/ml13例(19.4%)、4~10ng/ml32例(47.8%)、11~19ng/ml16例(23.9%)、≥20ng/ml6例(9.0%)。PPC≥33%38例(56.7%)。穿刺标本Cleason分组1组18例(26.9%)、2组23例(34.3%)3组12例(17.9%)、4组14例(20.9%)。采用logistic回归分析CCU的独立影响因素并建立列线图模型。采用受试者工作特征(ROC)曲线的曲线下面积(AUC)和校准曲线分别对模型进行效能评估(训练组)、内部验证(内部验证组)和外部验证(外部验证组)。结果训练组、内部验证组、外部验证组RP术后发生CGU分别为8716例(25.6%)、3677例(25.2%)、24例(35.8%)。logistic回归分析结果显示,穿刺标本Gleason分组(2组:0R=0.164,P<0.01;3组:0R=0.073,P<0.01;4组:0R=0.087,P<0.01)、PSA(4~10 ng/ml:0R=1.550,P<0.001;11~19 ng/ml:0R=2.084,P<0.01;≥20 ng/ml:0R=2.664,P<0.01)、年龄(60~69岁,0R=1.292,P<0.01;≥70岁,OR=1.550,P<0.01)、PPC(≥33%:0R=1.334,P<0.01)、种族(亚裔或太平洋岛民:OR=1.266,P<0.01)是GCU的独�Objective To explore the independent influencing factors of Gleason group upgrading(GGU)after radical prostatectomy(RP)of localized prostate cancer based on 2014 International Society of Urologic Pathology(ISUP)grouping system,then establish an effective prediction model.Methods The study included 48567 patients with localized prostate cancer who underwent radical prostatectomy from the surveillance,epidemiology and end results(SEER)database.The age was(61.1±7.0)years,including 39014 cases(80.3%),7063 cases(14.5%),2331 cases(4.8%),and 159 cases(0.3%)of White,Black,Asian or Pacific Islander,American Indian/Alaska Native.PSA<4 ng/ml,4-10 ng/ml,11-19 ng/ml,≥20 ng/ml were 6545 cases(13.5%),35007 cases(72.1%),5578 cases(11.5%),1437 cases(3.0%)respectively.Percent positive cores(PPC)≥33%were 24743 cases(50.9%).Gleason group of biopsy specimen:G118971cases(39.1%),G218446 cases(38.0%),C37093 cases(14.6%),G44057 cases(8.4%).Simple random sampling was assigned to the cases,divided them into training cohort and internal validation cohort according to the ratio of 7:3.67 patients with localized prostate cancer who treated in The Second Affiliated Hospital of Zhengzhou University during January 2017 to December 2021 were set as external validation cohort.All these cases were Asian with Chinese nationality,age(66.4±10.3)years.PSA<4 ng/ml,4-10 ng/ml,11-19 ng/ml,≥20 ng/ml were 13 cases(19.4%),32 cases(47.8%)16 cases(23.9%),6 cases(9.0%)respectively.PPC≥33%were 38 cases(56.7%).Cleason group of biopsy specimen:G118 cases(26.9%),G223cases(34.3%),C312 cases(17.9%),G414 cases(20.9%).The independent predictors of GGU were analyzed by logistic regression analysis,and the nomogram for predicting GGU were established.Then,the performance of nomograms was internally and externally validated via area under curve(AUC)and the calibration curve.Results There were 8716 cases(25.6%),3677 cases(25.2%)and 24 cases(35.8%)with CGU in the training group,internal validation group and external validation group,respectively.Logistic regressio

关 键 词：前列腺肿瘤 癌 前列腺切除术 穿刺活检 病理学 列线图 

分 类 号：R737.25[医药卫生—肿瘤]