高分级前列腺上皮内瘤预测前列腺癌的临床价值

Clinical value of high grade prostatic intraepitheliai neoplasia for predicting prostate cancer

目的研究高分级前列腺上皮内瘤（high grade prostatic introepithelial neoplasia，HGPIN）预测前列腺癌的临床价值。方法对243例经过前列腺特异性抗原、直肠指诊和经直肠超声（transrectal ultrasounds，TRus）检查出现异常的可疑前列腺癌患者行间隔1年为期2年的TRUS引导下的前列腺穿刺或经尿道前列腺电切，行组织活检及重复活检，对结果中存在HGPIN的实验组与无HGPIN的对照组进行分析研究。结果243例患者中失访2例，平均随访36个月。首次活检结果前列腺癌23例，其中伴HGPIN16例（69．6％）；HGPIN51例。第1次重复活检63例，诊断前列腺癌19例，其中伴HGPIN13例（68．4％），新发现HGPIN12例。第2次重复活检43例，前列腺癌11例，伴HGPIN7例（63．6％）；新发现HGPIN5例。实验组68例，对照组150例。前列腺癌伴HGPIN的发生率（67．9％）明显高于非前列腺癌患者（25．0％）（P〈0.05）。2组重复活检前列腺癌的检出率（实验组30．9％，对照组6．0％，P〈0.05）及2年无瘤生存率Log-Rank检验（P〈0.05）差异均有统计学意义。HGPIN诊断前列腺癌的敏感度和特异度的ROC检验P〈0．01，COX比例风险模型分析显示HGPIN是前列腺癌发生的危险因素。结论HGPIN与前列腺癌的发生有关，对诊断前列腺癌有预测价值。

Objective To study the clinical value of high grade prostatic intraepithelial neoplasia （HGPIN） for predicting prostate cancer. Methods Two hundred and forty-three patients with sus- picious prostate cancer by elevation of prostatic specific antigen （PSA）, abnormal digital rectal examination （DRE） and transrectal ultrasounds （TRUS）, in which the biopsies and re-biopsies were performed by transrectal needle or transurethral resection of prostate, were followed up for 2 years. The results of biopsies were analyzed statistically between the group with HGPIN and the group without. Results Of 243 cases, 241 received an average of 36 months follow-up （ranged 23 to 42 months）, in which 23 cases of prostate cancer were diagnosed on the first biopsy, HGPIN in 16 （69.6%）, and 51 showed HGPIN only. The first re-biopsy was done in 63 patients, with 19 diagnosed with prostate cancer, 13 accompanied by HGPIN （68.4%）, and with new diagnosed HGPIN in 12. The second rebiopsy was done in 43 patients, 11 patients were diagnosed with prostate cancer, 7 accompanied by HGPIN （63.6%）, and 5 showed new discovered HGPIN. Of 243 cases, 68 entered into the trial and 150 into the control. There was a significance in the incidence of HGPIN with prostate cancer （67.9%） compared to without（25.0%） （P〈0.05）, and it also showed a statistical significance in the incidence of prostate cancer on re-biopsy in which the trial and the control were 30.9%, 6.0%, respectively. The 2 years free-tumor survival was significant different between 2 groups（P〈0.05）. The ROC test of sensitivity and specificity for HGPIN predicting cancer showed P〈0.01, and HGPIN tes tified by COX ratio hazard model was a risk factor to diagnose prostate cancer. Conclusions HGPIN is related to the occurrence of prostate cancer, and it shows the predicting value to diagnose prostate cancer.