前列腺癌骨转移类型与前列腺特异性抗原及肿瘤分化程度的关系

Analysis of relation between types of bony metastasis and PSA and tumor differentiation of prostate cancer

目的分析不同类型的前列腺癌骨转移与血清前列腺特异性抗原（PSA）及Gleason评分的关系。方法整理北京积水潭医院44例前列腺癌骨转移病例，根据患者骨转移病灶影像学特点分为成骨型组、溶骨型组以及混合型组。分析血清总PSA以及前列腺穿刺标本Gleason评分在3组中有无差异。结果44例患者平均年龄70岁，其中成骨型骨转移33例（75．00％），溶骨型骨转移9例（20．45％），混合型骨转移2例（4．55％）。血清PSA均值在成骨型，溶骨型及混合型3组分别为（590．3±177．0）μg/L、（249．0±66．6）μg/L以及（156．5±42．1）μg/L，ANOVA分析显示3组之间血清PSA值差异无统计学意义（P〉0．05）；成骨型组中Gleason评分均值为7．4（6—10分），其中高中分化（Gleason评分≤7）22例（66．7％），低分化者（Gleason评分〉7）占11例（33．3％）；溶骨型组中Gleason评分均值为8．0分（6～10分），其中高中分化以及低分化分别为3例（33．3％）和6例（66．7％），统计学显示两组之间Gleason评分差异有统计学意义（P〈0．05）。混合型组两例Gleason评分均为8分。结论前列腺癌骨转移类型与血清PSA无关，与肿瘤的分化程度有关。

Objective To analyze the relationship between radiologicat characteristics of bony metastasis and PSA, Gleason score （GS） for prostate cancer patients. Methods The investigators collected the clinical data of 44 patients with prostate cancer bony metastasis and divided them into 3 groups based upon the radiological characteristics of bony metastasis. The 3 groups were osteoblast group, osteoclast group and mixed group. Results The mean age of patients was 70 years old. There were 33 cases （75.00%） , 9 cases （20.45%） and 2 cases （4.55%） in osteoblast group, osteoclast group and mixed group respectively. The mean total serum PSA values were 590.3 ＋ 177.0 p^g/L, 249.0 ＋66.6 p^g/L and 156.5 ＋42.1 p^g/L in osteoblast group, osteoclast group and mixed group respectively. No statistic significance was found for the difference of total PSA in 3 groups. Mean GS in osteoblast group was 7.4 （ 6-10 ）. Twenty-two cases （66. 7% ） were of a medium-high differentiation （GS≤7） while 11 cases （33.3%） of a low differentiation （GS 〉7）. Mean GS in osteoclast group was 8.0 （6-10）. Among which, 3 cases （33.3%） were of a medium-high differentiation while 6 cases （66.7%） of a low differentiation. Statistic significance was found for the difference of GS in 2 groups. Two cases in mixed group were assigned 8 of GS. Conclusion There is no confirmed correlation between types of bony metastasis and total serum PSA for prostate cancer patients. But the tumor differentiation reflected by Gleason score may affect the type of bony metastasis.