利用危险评分系统预测前列腺重复活检结果的临床研究

Risk scoring system to predict the possible results of prostate repeat biopsy

目的:探讨危险评分系统在提高前列腺重复活检阳性率方面的临床应用价值。方法:选择1999～2010年期间接受前列腺重复穿刺活检的129例患者作为本次研究对象,分别对其体质指数(BMI)、直肠指诊(DRE)、总前列腺特异抗原(tPSA)、游离前列腺特异抗原(fPSA)、游离与总前列腺特异抗原比值(f/tPSA)、前列腺体积(PV)、前列腺特异抗原密度(PSAD)、前列腺特异抗原速率(PSAV)、前列腺特异抗原倍增时间(PSADT)、前列腺体积与活检针数比率(VBR)等重复活检结果的潜在预测指标进行单变量分析和多元逐步罗吉斯逻辑回归分析并构建一套评分系统。结果:129例患者的重复活检结果显示BPH95例,前列腺癌(PCa)34例,前列腺重复活检阳性率为26.36%。分析结果证实DRE、tPSA、f/tPSA以及VBR等指标可作为重复活检结果的重要独立预测指标。参考相关独立预测指标而构建的评分系统显示:相比"危险评分"为0～2分的患者,3～5分的患者经重复活检前列腺癌的检出率更高(分别有10.13%和52.00%,P<0.001)。结论:通过研究发现的确存在预测前列腺重复活检结果的关键指标。利用预测指标构建一套评分系统,能够在实际工作中帮助临床医师判断究竟哪些患者更适合行前列腺重复穿刺活检术。

Objective：To examine the clinical value of risk scoring system to improve the positive rate of prostate repeat biopsies. Method： From 1999 to 2010,129 patients underwent transrectal ultrasound（TRUS）-guided repeat biopsies were included in present study. Potential predictors as age, body mass index（BMI）, digital rectal ex amination（DRE）, total PSA（tPSA）, free PSA（fPSA）, free-to-total PSA ratio（f/tPSA）, prostate volume（PV）, PSA density（PSAD） ,PSA velocity（PSAV） ,PSA doubling time（PSADT）and volume/biopsy ratio（VBR）were subjected to univariate analysis and multivariate stepwise logistic regression. Based on this model,a scoring system was con- structed as a tool predictive of prostate cancer in repeat biopsies. Result： Thirty-four patients（26.36%）were diag- nosed with prostate cancer. On a series of analysis, DRE, tPSA, f/tPSA and VBR were independently significant predictors. Moreover,based on the scoring system we know that patients with 3-5 risk scores had higher prostate cancer detection rate than those with 0-2 scores. Conclusion：Based on our findings, key predictors do exist that help formulate a scoring system enabling urologists to identify old men in need of repeat biopsies of their prostate glands.