经直肠与经会阴前列腺穿刺活检比较及前列腺癌检出率影响因素分析  

Comparison between transrectal andtransperineal prostate biopsy and analysis of influencing factors in prostate cancer detection rate

作　　者：桂迁 郭永连[1] GUI Qian;GUO Yonglian(Department of Urology,The Central Hospital of Wuhan,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院泌尿外科,武汉430014

出　　处：《现代泌尿生殖肿瘤杂志》2024年第4期216-222,共7页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：武汉市医学科研项目-重大项目(WX21M04)

摘　　要：目的对比超声引导下经直肠前列腺穿刺活检(TRB)与超声引导下经会阴前列腺穿刺活检(TPB)的前列腺癌(PCa)检出率及两种穿刺方式对腹腔镜前列腺癌根治术(LRP)术后国际泌尿病理协会(ISUP)分级一致性的影响,并分析PCa检出率的独立影响因素。方法对2018年1月至2022年12月在华中科技大学同济医学院附属武汉中心医院进行超声引导下前列腺穿刺活检的619位患者的临床资料进行回顾性分析,按穿刺途径分为TRB组(357例)和TPB组(262例)。运用卡方检验比较两种穿刺途径的PCa检出率及对LRP术后ISUP分级不一致的影响;采用单因素Logistic回归和向前逐步多因素Logistic回归分析PCa检出率的独立影响因素。结果TRB组和TPB组检出率分别为46.8%和55.0%,差异有统计学意义(P=0.044);TRB组和TPB组术后ISUP升级率分别为45.7%和30.4%,差异有统计学意义(P=0.039);TRB组和TPB组术后ISUP降级率分别为4.9%和12.0%,差异无统计学意义(P=0.102);多因素Logistic回归分析显示,年龄(OR=1.598,95%CI:1.266~2.016,P<0.001)、前列腺特异性抗原密度(PSAD)(OR=1.764,95%CI:1.318~2.359,P<0.001)、游离前列腺特异性抗原百分比(%fPSA)(OR=0.750,95%CI:0.590~0.953,P=0.019)、前列腺体积(PV)(OR=0.631,95%CI:0.495~0.804,P<0.001)及前列腺影像报告与数据系统(PI-RADS)评分(OR=4.910,95%CI:3.650~6.604,P<0.001)是PCa检出率的独立影响因素。结论TPB比TRB拥有更高的PCa检出率。不仅如此,TPB在降低LRP术后ISUP升级上,也有着显著优势。患者的年龄、%fPSA、PSAD、PV及PI-RADS评分是PCa的独立影响因素。Objective To compare the detection rate between ultrasound-guided transperineal(TRB)and transrectal(TPB)prostate biopsies for prostate cancer(PCa),evaluate their impact on the consistency of international society of uological pathology(ISUP)grade post-laparoscopic radical prostatectomy(LRP),and analyze the independent factors affecting PCa detection rate.Methods The medical records of 619 patients who underwent ultrasound-guided prostate biopsy in Central Hospital of Wuhan Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2022 were retrospectively analyzed.They were divided into TRB group(n=357)and TPB group(n=262)according to the puncture route.Chi-square test was used to compare the detection rate of PCa between two puncture approaches and the influence on the ISUP grade inconsistency after LRP.Univariate Logistic regression and forward stepwise Logistic regression were used to analyze the independent influencing factors in PCa detection rate.Results The detection rates of TRB group and TPB group were 46.8%and 55.0%respectively,and the difference was statistically significant(P=0.044).The upgrading rates of ISUP grade rates in TRB group and TPB group were 45.7%and 30.4%respectively,and the difference was statistically significant(P=0.039).The postoperative degradation rates of ISUP grade in TRB group and TPB group were 4.9%and 12.0%,respectively,and there was no significant difference(P=0.102).Multivariate Logistic regression analysis showed that age(OR=1.598,95%CI:1.266-2.016,P<0.001),prostate specific antigen density(PSAD)(OR=1.764,95%CI:1.318-2.359,P<0.001),percentage of free prostate specific antigen(%fPSA)(OR=0.750,95%CI:0.590-0.953,P=0.019),prostate volume(PV)(OR=0.631,95%CI:0.495-0.804,P<0.001),and prostate imaging reporting and data system(PI-RADS)score(OR=4.910,95%CI:3.650-6.604,P<0.001)were independent influencing factors in PCa detection rate.Conclusions TPB has a higher detection rate of PCa than TRB.Moreover,TPB has obvious advantage

关 键 词：前列腺癌 超声引导 经直肠前列腺穿刺活检术 经会阴前列腺穿刺活检术 

分 类 号：R737.25[医药卫生—肿瘤]