根治性前列腺切除术后PSA持续的预测模型构建与跨中心验证  

Development and validation of a prognostic model for predicting the persistence of prostate-specific antigen after radical prostatectomy

作　　者：沈显琦 张文辉 吉进 王燕[1] 瞿旻[1] 董振阳[1] 李嘉伦 周增辉 王杰 高旭[1] Shen Xianqi;Zhang Wenhui;Ji Jin;Wang Yan;Qu Min;Dong Zhenyang;Li Jialun;Zhou Zenghui;Wang Jie;Gao Xu(Department of Urology,Shanghai Changhai Hospital,Shanghai 200433,China;Department of Urology,Third Affiliated Hospital of Naval Medical University,Shanghai 201805,China)

机构地区：[1]上海长海医院泌尿外科,上海200433 [2]海军军医大学第三附属医院泌尿外科,上海201805

出　　处：《中华泌尿外科杂志》2025年第1期37-43,共7页Chinese Journal of Urology

基　　金：上海市优秀学术带头人计划项目(22XD1405000)。

摘　　要：目的探讨根治性前列腺切除术后前列腺特异性抗原(PSA)持续的术前影响因素,构建并验证PSA持续的预测模型。方法回顾性分析2015年1月至2023年12月于上海长海医院接受根治性前列腺切除术的1828例患者的临床资料,其中2015年1月至2021年4月的1295例作为建模组,2021年5月至2023年12月的533例作为验证组;并收集2023年3—12月于海军军医大学第三附属医院行根治性前列腺切除术的109例作为外部验证组。排除临床信息缺失、血清PSA>100 ng/ml和术前新辅助治疗的患者。建模组、验证组和外部验证组分别纳入1003、369、86例。建模组血清PSA中位值19.29(8.43,23.73)ng/ml;临床分期T_(1)、T_(2)、T_(3)、T_(4)期分别为191、673、123、16例;穿刺主要Gleason评分3、4、5分分别为460、466、77例,次要Gleason评分3、4、5分分别为363、486、154例。验证组血清PSA 12.80(6.82,14.40)ng/ml;临床分期T_(1)、T_(2)、T_(3)、T_(4)期分别为40、289、37、3例;穿刺主要Gleason评分3、4、5分分别为218、145、6例,次要Gleason评分3、4、5分分别为140、184、45例。外部验证组血清PSA 12.84(7.11,12.97)ng/ml;临床分期T_(1)、T_(2)、T_(3)期分别为9、68、9例;穿刺主要Gleason评分3、4、5分分别为58、27、1例,次要Gleason评分3、4、5分分别为28、50、8例。采用logistic回归分析建模组根治性前列腺切除术后PSA持续的独立危险因素并构建预测模型。采用受试者工作特征(ROC)曲线的曲线下面积(AUC)、校准曲线和临床决策曲线分析预测模型的预测效能,并通过ROC曲线在验证组和外部验证组中进行验证。结果建模组、验证组和外部验证组术后PSA持续的发生率分别为8.97%(90/1003)、7.32%(27/369)和17.4%(15/86)。建模组中,单因素和多因素logistic回归分析结果显示血清PSA、穿刺阳性针数百分比、穿刺主要Gleason评分和穿刺次要Gleason评分为PSA持续的独立危险因素(P<0.05),并以此构建预测ObjectiveTo investigate the factors influencing the persistence of prostate specific antigen(PSA)following radical prostatectomy,and to develop and validate a predictive model for PSA persistence.MethodsClinical data from 1828 patients who underwent radical prostatectomy at Shanghai Changhai Hospital between January 2015 and December 2023 were retrospectively analyzed.Of these,1295 patients from January 2015 to April 2021 comprised the modeling group,while 533 patients from May 2021 to December 2023 formed the validation group.Additionally,109 patients who underwent radical surgery at the Third Affiliated Hospital of Naval Medical University between March and December 2023 were included as an external validation group.Patients with incomplete clinical information,serum PSA levels exceeding 100 ng/ml,or those who received preoperative neoadjuvant therapy were excluded.Ultimately,1003,369,and 86 patients were included in the modeling,validation,and external validation groups,respectively.The modeling group had serum PSA of 19.29(8.43,23.73)ng/ml;the clinical stages were distributed as T_(1),T_(2),T_(3),and T_(4) in 191,673,123,and 16 patients,respectively;the primary Gleason scores of biopsy were 3,4,and 5 in 460,466,and 77 patients,respectively;and the secondary Gleason scores were 3,4,and 5 in 363,486,and 154 patients,respectively.The validation group had serum PSA of 12.80(6.82,14.40)ng/ml;the clinical stages were distributed as T_(1),T_(2),T_(3),and T_(4) in 40,289,37,and 3 patients,respectively;the primary Gleason scores of biopsy were 3,4,and 5 in 218,145,and 6 patients,respectively;and the secondary Gleason scores were 3,4,and 5 in 140,184,and 45 patients,respectively.The external validation group had serum PSA of 12.84(7.11,12.97)ng/ml;the clinical stages were distributed as T_(1),T_(2) and T_(3) in 9,68,and 9 patients,respectively;the primary Gleason scores of biopsy were 3,4,and 5 in 58,27,and 1 patient,respectively;and the secondary Gleason scores were 3,4,and 5 in 28,50,and 8 patients,respectively.Logis

关 键 词：前列腺肿瘤 癌 前列腺特异性抗原持续 列线图 预测 

分 类 号：R737.25[医药卫生—肿瘤]