前列腺体积与前列腺癌的非线性关系研究  

Research on the nonlinear relationship between prostate volume and prostate cancer

作　　者：李杰[1] 顾腾飞 丁佳锋 谢丽丹[2] 李颖[2] 毛卫波[3] 陈挺[1] LI Jie;GU Tengfei;DING Jiafeng;XIE Lidan;LI Ying;MAO Weibo;CHEN Ting(Department of Urology,Lishui Central Hospital,Lishui 323000,China;不详)

机构地区：[1]丽水市中心医院泌尿外科,323000 [2]丽水市中心医院超声科,323000 [3]丽水市中心医院病理科,323000

出　　处：《浙江医学》2023年第20期2149-2152,2176,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023RC114);丽水市科技计划项目(2023GYX69)。

摘　　要：目的探讨前列腺体积(PV)与前列腺癌(PCa)的非线性关系。方法选取2021年1月至2023年3月在丽水市中心医院因前列腺特异性抗原(PSA)升高或前列腺影像学检查异常初次行前列腺穿刺活检的792例患者为研究对象,按照PV四分位数分为4组,即Q1组(PV≤32.3 cm^(3))、Q2组(PV>32.3~46.1 cm^(3))、Q3组(PV>46.1~65.6 cm^(3))、Q4组(PV>65.6 cm^(3)),每组198例。比较4组患者PSA、游离PSA(fPSA)、fPSA/总PSA(f/tPSA)、PSA密度(PSAD)、尿酸(UA)以及影像学检查结果等临床资料。采用广义相加模型分析PV与PCa的非线性关系。采用logistic回归模型分析PCa风险的影响因素。结果不同PV患者PSA、fPSA、f/tPSA、PSAD、UA以及超声弹性成像异常、超声造影异常、MRI异常、PCa的比例比较,差异均有统计学意义(均P<0.05)。调整年龄、UA、超声低回声结节、超声弹性成像异常、MRI异常等因素后,广义相加模型分析显示PV与PCa之间存在L形曲线关系:当PV≤46.1 cm^(3)时,随着PV增加,PCa风险降低(P<0.05);当PV>46.1 cm^(3)时,随着PV增加,PCa风险变化差异无统计学意义(P>0.05);logistic回归模型分析显示,以Q3组为参照,Q1组、Q2组PCa风险均明显增加,其OR值及95%CI分别为10.19(4.48~23.21)、4.19(1.94~9.04),差异均有统计学意义(均P<0.05),而Q4组差异无统计学意义(P>0.05)。结论PV与PCa风险呈L形曲线关系,当PV>46.1 cm^(3)时,随着PV增大,PCa风险变化不明显。Objective To investigate the nonlinear relationship between prostate volume(PV)and prostate cancer(PCa).Methods A total of 792 patients who underwent prostate biopsy for the first time due to increased prostate-specific antigen(PSA)or abnormal prostate imaging results in Lishui Central Hospital from January 2021 to March 2023 were selected for the study,and were divided into four groups according to the PV quartiles,that is,group Q1(PV≤32.3 cm^(3)),group Q2(PV>32.3-46.1 cm^(3)),group Q3(PV>46.1-65.6 cm^(3)),and group Q4(PV>65.6 cm^(3)),with 198 cases in each group.Clinical data including PSA,free PSA(fPSA),fPSA/total PSA(f/tPSA),PSA density(PSAD),uric acid(UA),and imaging findings were compared among the 4 groups.A generalized additive model was used to analyze the nonlinear relationship between PV and PCa.Logistic regression model was used to analyze the influencing factors of PCa risk.Results Comparison of the proportions of PSA,fPSA,f/tPSA,PSAD,UA,and ultrasound elastography abnormality,ultrasound contrast abnormality,MRI abnormality,and PCa in patients with different PV showed statistically significant differences(all P<0.05).After adjusting for age,UA,ultrasound hypoechoic nodule,ultrasound elastography abnormality,and MRI abnormality,the generalized additive model analysis showed an L-shaped curve in the relationship between PV and PCa:when PV≤46.1 cm^(3),the risk of PCa was decreased as PV increased(P<0.05);when PV>46.1 cm^(3),the risk of PCa remained unchanged as PV increased(P>0.05);logistic regression model analysis showed that,by using the Q3 group as a reference,the PCa risk was significantly increased in the Q1 and Q2 groups,with OR and 95%CI of 10.19(4.48-23.21)and 4.19(1.94-9.04),respectively,and the differences were statistically significant(both P<0.05),while the differences in the Q3 group were not statistically significant(P>0.05).Conclusion The relationship between PV and PCa risk showed an L-shaped curve,with PCa risk remaining unchanged as PV increased when PV>46.1 cm^(3).

关 键 词：前列腺癌 前列腺体积 非线性关系 前列腺穿刺活检 

分 类 号：R737.25[医药卫生—肿瘤]