初诊未治PSA≥20 ng/mL高度可疑前列腺癌患者临床特征的10年真实世界数据分析  

Ten-year real-world data analysis of clinical characteristics in treatment-naive patients with highly suspected prostate cancer and PSA level≥20 ng/mL

作　　者：彭保龙 陈铭哲 王俊欣 刘冉录[1,2] 马宝杰 郭姗琦[4] 姜行康 PENG Baolong;CHEN Mingzhe;WANG Junxin;LIU Ranlu;MA Baojie;GUO Shanqi;JIANG Xingkang(Department of Urology,Tianjin Medical University Second Hospital,Tianjin 300211;Department of Urology,Tianjin Medical University General Hospital,Tianjin 300000;Department of Urology,Huai'an Hospital,Huai'an 223200;Department of Oncology,The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)

机构地区：[1]天津医科大学第二医院泌尿外科,天津300211 [2]天津医科大学总医院泌尿外科,天津300000 [3]淮安市淮安医院泌尿外科,江苏淮安223200 [4]天津中医药大学第一附属医院,国家中医针灸临床医学研究中心肿瘤科,天津300381

出　　处：《现代泌尿外科杂志》2025年第1期13-21,共9页Journal of Modern Urology

基　　金：国家自然科学基金项目(No.82174174);天津市卫生健康委项目(No.KJ20169);天津医科大学第二医院科技项目(No.MNRC202312,No.MYSRC202306)。

摘　　要：目的分析初诊未治前列腺特异性抗原(PSA)≥20 ng/mL高度可疑前列腺癌(PCa)患者的临床病理特征,以期为推进PCa的早期筛查工作提供参考。方法回顾性分析2013年1月—2023年6月于天津医科大学第二医院泌尿外科就诊的初诊未治PSA≥20 ng/mL高度可疑PCa而进行前列腺穿刺活检患者的临床资料。评估患者的年龄、身体质量指数(BMI)、PSA水平、前列腺体积(PV)、前列腺特异性抗原密度(PSAD)、前列腺影像报告和数据系统(PI-RADS)、国际泌尿学会评分(ISUP)等指标与高度可疑PCa转移情况和PSA分层的相关性。结果本研究共纳入1778例PSA≥20 ng/mL高度可疑PCa患者进行前列腺穿刺活检。病理结果证实1465例(82.4%)患者为PCa,其中487例(33.2%,487/1465)患者为转移性PCa。近10年,因PSA≥20 ng/mL的高度可疑PCa而进行前列腺穿刺活检的患者数量和确诊PCa患者数量逐年增加,而转移性PCa患者占比持续维持在30%。相比于PSA 20~50 ng/mL组,PSA>50 ng/mL组的患者年龄更大、BMI更低、城市人口的占比更低、PSAD更高、PI-RADS评分及ISUP分组更高、特殊病理类型更多以及转移比例更高,差异均有统计学意义(P<0.05)。转移性PCa中有46.8%(228/487)寡转移(转移灶≤5处),其中99.0%骨转移、4.1%区域外淋巴结转移、4.3%其他器官转移。结论近10年,初诊未治PSA≥20 ng/mL高度可疑PCa患者的穿刺活检人数和新确诊PCa患者人数逐年增加,但是转移性PCa患者占比依然较高。因此,应积极推动高危可疑PCa患者的早期筛查工作。Objective To analyze the clinicopathological characteristics of treatment-naive patients with highly suspected prostate cancer(PCa)with prostate-specific antigen(PSA)level≥20 ng/mL,to provide reference for promoting early screening of PCa.Methods A retrospective analysis was conducted on the clinical data of treatment-naive patients with PSA level≥20 ng/mL,undergoing prostate biopsy for highly suspected PCa at the Department of Urology,Tianjin Medical University Second Hospital during Jan.2013 and Jun.2023.The correlation between patients age,body mass index(BMI),PSA,prostate volume(PV),prostate cancer-specific antigen density(PSAD),prostate imaging reporting and data system(PI-RADS)score,and International Society of Urological Pathology(ISUP)grade with highly suspected PCa metastasis and PSA stratification were analyzed.Results A total of 1778 suspected patients were enrolled.Pathological findings confirmed PCa in 1465 cases(82.4%),with 487(33.2%)diagnosed as metastatic PCa.Over the past decade,the number of patients undergoing prostate biopsy for highly suspected PCa and being confirmed has been increasing annually,with the proportion of metastatic cases remaining at around 30%.Compared with those with PSA level being 20-50 ng/mL,patients with PSA level>50 ng/mL had older age,lower BMI,higher PSAD,higher PI-RADS,higher ISUP,more diverse pathological types,and a higher incidence of metastasis(P<0.05)with lower proportion of urban residents.Additionally,analysis of metastatic PCa cases showed that 46.8%(228/487)had oligometastasis(≤5 metastatic lesions),including 99.0%bone metastasis,4.1%extraregional lymph node metastasis,and 4.3%other organ metastasis.Conclusion Over the past 10 years,there has been a continuous increase in the number of treatment-naive biopsied cases and newly diagnosed cases of highly suspicious PCa with PSA level≥20 ng/mL,while the proportion of metastatic cases remains high.Therefore,proactive efforts should be made to promote early screening of high-risk suspected cases.

关 键 词：前列腺癌 前列腺特异性抗原 局限性前列腺癌 转移性前列腺癌 早期筛查 

分 类 号：R712[医药卫生—妇产科学]