前列腺特异性抗原密度预测根治性前列腺癌切除术后复发情况分析

Analysis on recurrence of prostate specific antigen density prediction after radical prostatectomy

目的探讨测定前列腺特异性抗原密度(PSAD)在前列腺癌根治性切除术后预测患者复发或转移情况的临床价值。方法采用回顾性分析方法对2010年1月至2012年1月在我院行前列腺根治切除术的46例患者的临床资料进行分析,对46例患者根治术后进行随访观察24个月,测定患者根治术前列腺特异性抗原(PSA)、前列腺体积、前列腺特异性抗原密度(PSAD)指标,并根据患者术后24个月内是否出现复发或转移进行分组,比较上述指标在两组间的差异。结果术后对所有患者进行24个月随访观察,在这期间共有14例患者经检查出现复发或转移,分成复发组和非复发组,两组术前的PSA、前列腺体积、PSAD分别为复发组(72.84±31.54、104.51±38.63、0.697±0.141),非复发组(44.67±24.63、74.82±31.93、0.567±0.086),复发组术前的PSA、前列腺体积、PSAD均显著的高于非复发组且差异均具有统计学意义(P<0.05);PSAD值预测复发例数为16例,术后随访观察实际复发例数为14例,比较差异不具有统计学意义(χ2=0.198,P=0.656>0.05);PSA预测复发例数20例,实际复发14例,统计分析差异具有统计学意义(χ2=5.251,P=0.021<0.05);采用PSAD预测与PSA预测结果比较差异不具有统计学意义(χ2=0.889,P=0.346)。采用PSAD进行前列腺癌术后复发预测的灵敏度=85.71%,特异度=81.25,误诊率=18.75%,漏诊率=14.29%,诊断指数=1.670,Youden指数=0.670,ROC曲线下面积AUC=0.873。结论通过术前测定前列腺癌患者的PSAD值可以较为准确的对前列腺癌根治切除术后患者的复发情况进行预测,从而为术后治疗方案提供依据。

Objective Determination of prostate specific antigen density（ PSAD） in prostate cancer after radical resection in patients with recurrent or metastasispredictive value of Linchuan. Methods The method for the analysis of clinical data of 46 cases from January 2010 to 2012 January in our hospital underwent radical prostatectomypatients were analyzed retrospectively,and observed for 24 months in 46 cases of patients after radical surgery were followed up,prostate specific antigen in patients with radical resection of anterior（ PSA）,prostate volume,prostate specific antigen density（ PSAD） index,and according to the patients after 24 months if there is recurrence or metastasis group,differences between the above indexes between two groups. Results After the operation,all patients were followed up for 24 months,during which there were recurrence or metastasis after inspection occurred in 14 patients,divided into recurrence group and non recurrence group,two groups of preoperative PSA,prostate volume,PSAD were recurrent group（ 72. 84 ± 31. 54,104. 51 ± 38. 63,0. 697 ± 0.141）,non recurrent group（ 44. 67 ± 24. 63,74. 82 ± 31. 93,0. 567 ± 0. 086）,recurrent group preoperative PSA,prostate volume,PSAD were significantly higher than those in the non recurrence group and the differences were statistically significant（ P〈0. 05）; the PSAD value to predict the recurrence were 16 cases,postoperative follow-up observation of actual complex number of cases in 14 patients, compared the difference was not statistically significant（ χ^2= 0. 198,P = 0. 656 0. 05）; PSA predicts 20 recurrent cases,actual recurrence in14 cases,statistical analysis,the difference was statistically significant（ χ^2= 5. 251,P = 0. 021 0. 05）; the PSAD forecast and PSA forecast the difference was not statistically significant（ χ2= 0. 889,P = 0. 346）.Sensitivity = 85. 71% using PSAD to predict the recurrence of prostate cancer after operation,the specificity =81. 25,the rate of misdiagnosis = 18. 75%,missed diagnosis rate of = 14. 29%,diagnosis index = 1. 670,Youden index = 0. 670,the area under ROC curve AUC = 0. 873. Conclusions Through the preoperative determination in patients with prostate cancer and PSAD value can be more accurate to radical prostatectomy in patients with recurrence after resection of prediction,so as to provide the basis for postoperative treatment.