血清前列腺特异性抗原小于20μg/L患者前列腺穿刺标本中炎症分级与前列腺癌的相关性分析

Association between prostate histologic inflammation classification and prostate cancer in needle biopsy specimens with serum PSA under 20 μg/L

目的 研究血清前列腺特异性抗原（PSA） ＜20 μg/L患者前列腺穿刺活检标本中前列腺组织学炎症分级与前列腺癌（prostate cancer,PCa）之间的关系.方法 回顾性分析2011年1月至2013年12月前列腺穿刺活检患者的资料.患者入组标准：①主诉血清总PSA（total PSA,tPSA）升高入院,行前列腺穿刺;②血清tPSA＜20 μg/L;③无盆腔放疗史.对前列腺穿刺标本组织学炎症的位置、范围以及程度进行评估并分级,探讨组织学炎症分级与PCa之间的相关性.结果 入组病例226例,前列腺穿刺活检诊断PCa 84例（37.2％）,良性前列腺疾病（benign prostatic disease,BPD） 142例（62.8％）.PCa和BPD患者前列腺组织学炎症的位置（P＜0.001）、范围（P＜0.001）以及程度（P=0.004）分级比较差异均有统计学意义.多因素Logistic回归分析发现,组织学炎症位置（P=0.001,OR=0.114,95％CI 0.032～ 0.405）以及炎症范围（P=0.021,OR=0.232,95％CI 0.067～ 0.804）与PCa风险呈负相关,炎症程度与PCa无相关性（P=0.223,OR=1.805,95％ CI0.698 ～ 4.667）.在前列腺穿刺标本中运用炎症位置和炎症范围来区分PCa和BPD的敏感性、特异性、阳性预测值和阴性预测值分别为91.7％、50.7％、52.4％和91.1％.结论 前列腺组织学炎症位置和炎症范围分级与PCa呈负相关.

Objective To investigate the relationship between prostate histologic inflammation classification and prostate cancer （PCa） in needle biopsy specimens with serum prostatic specific antigen （PSA） under 20 μg/L.Methods The clinical records of patients who underwent prostate biopsy were retrospectively analyzed in Beijing Hospital Urological Department from January 2011 to December 2013.The patients underwent prostate biopsy because of PSA raised and without pelvic radiotherapy.The needle biopsy specimen was evaluated by the pathohistologic criteria of location,extent and grade classification of prostate inflammation.Results PCa was detected in 84 （37.2%） biopsies and benign prostatic disease （BPD） in 142 （62.8%） biopsies.There were significant differences between PCa and BPD in inflammation classification （location：P〈0.001,extent：P〈0.001,grade：P〈0.001）.On multivariable Logistic regression analysis,both location and extent classification of chronic histologic prostatitis were found tobe significantly associated with a lower risk of PCa in biopsy （location：P =0.001,OR =0.114,95% CI 0.032-0.405 ; extent：P =0.021,OR =0.232,95% CI 0.067-0.804）.There was no relationship between grade classification and PCa （P=0.223,OR=1.805,95%CI 0.698-4.667）.Under the evaluation of location and extent classification,it could differentiate PCa with BPD in biopsy with a sensitivity,specificity,positive predictive value and negative predictive value of 91.7%,50.7%,52.4%,91.1%,respectively.Conclusion The location and extent classification of chronic prostatitis is found to be associated with a lower risk of PCa independently.