PI-RADS评分联合SII对局限性前列腺癌患者根治术后病理升级的预测价值  

The value of PI-RADS score combined with SII in predicting pathological upgrading in patients with localized prostate cancer post-radical prostatectomy

作　　者：樊长晖[1] 黄志恒 许长宝[1] 徐寒 魏海洋 张天贺 高俊峰 Fan Changhui;Huang Zhiheng;Xu Changbao;Xu Han;Wei Haiyang;Zhang Tianhe;Gao Junfeng(Department of Urology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450014

出　　处：《中华泌尿外科杂志》2024年第12期905-911,共7页Chinese Journal of Urology

摘　　要：目的探讨前列腺影像报告和数据系统2.1版(PI-RADS v2.1)评分联合全身免疫炎症指数(SII)预测局限性前列腺癌患者根治性前列腺切除术后病理升级的价值。方法回顾性分析2019年9月至2024年5月郑州大学第二附属医院收治的76例局限性前列腺癌患者的临床资料。年龄68(65,71)岁。总前列腺特异性抗原(tPSA)17.4(8.4,30.9)ng/ml。前列腺体积43.1(29.9,58.9)ml。PI-RADS评分≤3分22例(28.9%),>3分54例(71.1%)。所有患者均接受前列腺穿刺活检和根治性前列腺切除术。穿刺病理国际泌尿病理学会(ISUP)分级分组<3组31例(40.8%),≥3组45例(59.2%);术后病理ISUP分级分组<3组25例(32.9%),≥3组51例(67.1%)。病理升级定义:①术后病理ISUP分级分组高于穿刺病理ISUP分级分组;②穿刺病理为良性前列腺组织但术后确诊为前列腺癌。比较升级组和未升级组的临床资料。采用单因素和多因素logistic回归分析评估影响病理升级的独立危险因素,并构建列线图模型。绘制受试者工作特征(ROC)曲线,评价PI-RADS评分、SII、游离前列腺特异性抗原比例(%PSA)、穿刺肿瘤组织占比等4项指标单独应用,以及列线图模型在预测病理升级方面的效能。采用交叉验证进行内部验证,采用校准曲线和决策曲线评估列线图模型的预测准确性和临床净效益。结果本研究76例,术后病理降级10例(13.2%),与术前一致36例(47.4%),病理升级30例(39.5%)。升级组的血小板淋巴细胞比值(PLR)[118.2(93.5,139.1)与95.2(79.3,116.4),P=0.021]、SII[394.8(331.0,513.6)与338.8(217.2,407.8),P=0.002]、PI-RADS评分>3分例数[26例(86.7%)与28例(60.9%),P=0.015]高于未升级组,穿刺阳性针数百分比[35.9%(12.6%,51.8%)与43.8%(21.0%,92.1%),P=0.045]、穿刺肿瘤组织占比[6.9%(1.3%,20.1%)与19.3%(9.1%,58.4%),P<0.01]和穿刺病理ISUP分级分组≥3组例数[12例(40.0%)与33例(71.7%),P=0.006]低于未升级组。单因素和多因素分析结果显示,PI-RADS评分(ORObjective To investigate the application value of combining Prostate Imaging Reporting and Data System(PI-RADS v2.1)score and Systemic Immune-Inflammation Index(SII)in predicting pathological upgrading in patients with localized prostate cancer after radical prostatectomy(RP).Methods A retrospective analysis was conducted on clinical data from 76 patients with localized prostate cancer who underwent prostate biopsy and radical prostatectomy at the Second Affiliated Hospital of Zhengzhou University between September 2019 and May 2024.The median age was 68(65,71)years.Total prostate-specific antigen(tPSA)was 17.4(8.4,30.9)ng/ml,and prostate volume was 43.1(29.9,58.9)ml.PI-RADS scores were≤3 in 22 cases(28.9%)and>3 in 54 cases(71.1%).According to the International Society of Urological Pathology(ISUP)grading of biopsy specimens,31 patients(40.8%)were classified as Group<3 and 45 patients(59.2%)as Group≥3.Postoperatively,25 patients(32.9%)were classified as ISUP Group<3,and 51 patients(67.1%)as Group≥3.Pathological upgrading was defined as either:a higher ISUP grade in postoperative specimens compared to biopsy specimens or;benign prostate tissue identified in biopsy specimens but confirmed as prostate cancer postoperatively.Clinical data were compared between the pathological upgrade and non-upgrade groups.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for pathological upgrading and to construct a nomogram model.Receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of individual indicators(PI-RADS,SII,%PSA,and the proportion of tumor tissue in biopsy specimens)and the combined nomogram model.Internal validation was conducted using cross-validation,and calibration and decision curves were generated to assess the nomogram's accuracy and clinical net benefit.Results Among the 76 patients included,10(13.2%)experienced pathological downgrading,36(47.4%)had consistent grading,and 30(39.5%)experienced pathological up

关 键 词：前列腺肿瘤 前列腺影像报告和数据评分系统 全身免疫炎症指数 病理升级 预测模型 

分 类 号：R73[医药卫生—肿瘤]