单中心中国初诊前列腺癌患者骨转移预测因素分析

Independent predictors of bone metastases at the initial stage of prostate cancer diagnosis:a single center analysis in Chinese patients

目的界定国人初诊前列腺癌患者骨转移高危因素,初步确定骨转移极低风险患者特征。方法收集2010年至2015年在第二军医大学长海医院初次确诊的496例前列腺癌患者的临床资料。所有患者确诊后均行^(99m)Tc MDP注射的全身骨骼ECT扫描。分析所有患者确诊时的年龄、穿刺前末次前列腺特异抗原(PSA)、临床T分期、前列腺穿刺Gleason评分及骨扫描、相应MRI/CT结果。用单因素及多因素logistic回归方法得出预测骨转移的相关临床指标。结果 496例患者中,81例(16.3%)存在骨转移。骨转移组与无骨转移组的年龄无差异,但骨转移组患者PSA水平大于无骨转移组(P<0.001)。随着PSA水平、临床T分期或穿刺Gleason评分升高,骨转移风险增大(P<0.001)。单因素logistic回归分析显示,穿刺前PSA>20ng/mL、临床T分期为T3~T4和活检Gleason评分≥8是骨转移的影响因素。多因素logistic回归显示,PSA>50ng/mL和活检Gleason评分≥8是骨转移的独立预测因素。初诊PSA≤20ng/mL且Gleason评分≤6的79例前列腺癌患者无一例出现骨转移。结论初诊PSA≤20ng/mL且Gleason评分≤6的中国前列腺癌患者骨转移发生率非常低,这部分患者在初诊时不需要行骨扫描检查。

Objective To indentify the high risk factors of bone metastasis in Chinese patients at the initial stage of prostate cancer （PCa） diagnosis, so as to elucidate the characteristics of patients with very low risk of bone metastasis at the initial stage of prostate cancer. Methods A consecutive series of 496 patients with newly diagnosed PCa between 2010 and 2015 were enrolled in the present study. All the patients were subjected to ECT scan for presence of bone metastasis （BM） using total-body 99mWc MDP scintigraphy regardless of baseline PCa characteristics. Factors including the age of diagnosis, prostate specific antigen （PSA） level at diagnosis, Gleason score, clinical T stage, bone scan and CT/MRI results were analyzed. Univariate and multivariate logistic regression analyses were performed to identify the predictors of bone metastases. Results Of the 496 patients, 81 patients （16. 3%） had bone metastases. The PSA levels of patients with BM were significantly higher than those without BM （P〈0. 001）. The mean age of the patients with BM was not significantly older than that of the patients without BM. Patients with higher PSA level, clinical T stage or Gleason score showed a significantly higher risk of BM （P〈0. 001）. Univariate logistic regression analysis showed that PSA〉20 ng/mL at diagnosis, clinical stage at T3-T4 and Gleason score≥8 were the risk factors of bone metastasis in PCa patients. The multivariate analysis showed that the PSA level〉50 ng/ mL and the Gleason score≥8 were the independent predictors of bone metastases. No bone metastasis was found in 79 patients with PSA≤20 ng/mL and at the same time with Gleason score≤6. Conclusion The bone metastases rate is very low in Chinese patients with a PSA level ≤20 ng/mL and at the same time with Gleason score≤6, so a bone scan is not necessary as a routine for these patients with newly diagnosed prostate cancer.