PSAD预测前列腺癌根治术前后Gleason评分变化的临床应用价值

Clinical application of the PSAD value predicting the change in Gleason score after radical prostatectomy in prostate cancer patients

目的:探讨前列腺根治术前血清前列腺特异性抗原密度(PSAD)预测术后Gleason评分变化的应用价值。方法:对133例行前列腺癌根治术的患者资料进行回顾,将前列腺癌根治术前术后Gleason评分变化与患者年龄、术前Gleason评分、前列腺特异性抗原(PSA)、前列腺体积和PSAD的相关性进行分析,并进一步分析术前Gleason评分≤6患者中评分升高和Gleason评分≥7患者中评分下降与上述因素的关系。结果:133例患者中经直肠超声(TRUS)引导下前列腺穿刺活检Gleason评分与前列腺癌根治术后Gleason评分保持一致52例(39.1%),评分下降13例(9.8%),评分升高68例(51.1%)。PSAD(P=0.002)与Gleason评分升高明显相关,未发现Gleason评分≥7患者中评分下降与前列腺特异性抗原(PSA)、前列腺体积和PSAD有相关性。进一步应用受试者工作特征(receiver operating characteristic,ROC)曲线分析得出:TRUS穿刺活检Gleason评分≤6患者PSAD>0.2435预示根治术后Gleason评分升高可能性较大。结论:TRUS引导下前列腺穿刺活检Gleason评分较低且PSAD较高的前列腺癌患者提示有可能实际Gleason评分升高,进而影响治疗选择和预后。

Objective：To investigate the clinical application value of PSAD predict differences in Gleason score between biopsy and radical prostatectomy in prostate cancer patients. Method： We retrospectively analyzed the medical records of 133 patients who underwent a radical prostatectomy. The association between Gteason score changes and age, preoperative Gleason score, prostate-specific antigen （PSA）, prostate volume and PSA density were analyzed. We also analyzed the factors that influence upgrading in patients with preoperative Gleason score≤ 6 and downgrading in patients with Gleason score ≥. Result： No difference in Gleason score was noted in 52 cases （39.1%）, while a downgrade was noted in 13 cases （10.6%） and upgrade in 68 cases （51.1%）. PSAD （ P =0. 002） was significantly correlated with upgrade, No significant score ≥ who downgrade postoperatively. Based on the ROC characteristics were found for patients with Gleason analysis, a cut-off value of PSAD 〉0. 2435 was as- sociated with higher incidence of upgrade. Conclusion： Lower Gleason score and higher values of PSA are potential predictors for upgrade in patients who underwent TRUS guided prostate biopsy, influence therapeutic decision- making and prognosis.