血清tPSA、PSAD及Gleason评分在前列腺癌分期中的应用价值

Total PSA,PSA density and biopsy Gleason score in predicting the pathologic stage of prostate cancer

目的:探讨血清前列腺特异性抗原(PSA)系列及穿刺组织活检Gleason评分在前列腺癌病理分期的预测价值。方法:回顾性分析我院1999～2008年病理证实为前列腺腺癌的124例患者资料,将该124例患者根据术后病理、骨扫描和CT或MRI结果分为A、B两组。骨扫描、CT、MRI或术后证实为有周围浸润或远处转移者归为A组;无周围浸润且无远处转移者归为B组。比较两组之间以上各指标的差异。通过多因素回归分析筛选前列腺癌病理分期的影响因子。运用工作特征曲线(ROC曲线)比较各指标的预测价值。结果:tPSA、穿刺活检Gleason评分值A组明显高于B组(P<0.05);多元Logistic回归分析中,仅tPSA进入模型,被认为是最主要的预测因子。ROC曲线对前列腺病理分期预测效力比较:联合分析tPSA与穿刺活检Gleason评分预测效果明显高于其他指标,工作特征曲线下面积(AUC)从大到小依次为Gleason评分+tPSA>tPSA>PSAD+tPSA+Gleason评分。结论:tPSA依然是临床上对前列腺癌病理分期较好的预测因素;联合穿刺组织活检Gleason评分,可以提高预测准确度,对指导临床治疗和预后有重要意义。

Objective：To evaluate the roles of total prostate specific antigen （tPSA）,PSA density （PSAD） and biopsy Gleason score in predicting the pathologic stage of prostate cancer.Methods：We retrospectively analyzed the clinical data of 124 cases of pathologically confirmed prostate adenocarcinoma,and divided them into Groups A （n = 48） and B （n = 76） based on the results of bone scanning,CT,MRI,tPSA,PSAD and postoperative biopsy Gleason score,the former with extraprostatic infiltration or distant metastasis,while the latter without.We compared the above parameters between the two groups,screened the main factors that influenced the pathologic staging of prostate cancer by multivariate logistic regression analysis,and appraised the value of each of the para-meters in predicting the pathologic stage of prostate cancer with a relative operating characteristic （ROC） curve.Results：The tPSA level and biopsy Gleason score were significantly higher in Group A than in B （P0.05）.Multivariate logistic regression analysis showed that only tPSA could predict the pathologic stage of localized prostate cancer.The ROC curve exhibited that the combined use of tPSA and Gleason score had a better predicting value than other parameters （Gleason score ＋ tPSA tPSA PSAD ＋ tPSA ＋ Gleason score）.Conclusion：Total PSA remains a valuable predictor of the pathologic stage of prostate cancer,and its combination with Gleason score can further improve the predictive accuracy and contribute much to the treatment and prognosis of the disease.