前列腺初次穿刺活检阳性的预测因素分析

Factors analysis about predicting the probability of positive initial prostate biopsy

目的 研究临床指标在预测前列腺初次穿刺活检阳性中的价值.方法 回顾性分析2010年1月至2013年12月收治的658例前列腺初次穿刺活检患者的临床资料.临床资料以中位值（四分位间距）表示,年龄69（64,75）岁,前列腺体积（prostate volume,PV）44.8（30.9,65.8） ml,tPSA15.1（9.0,30.8） μg/L,fPSA/tPSA为0.14（0.10,0.23）,前列腺特异性抗原密度（prostate specific antigen density,PSAD）0.33（0.18,0.80）.直肠指检阳性324例（49％）,经直肠超声（transrectal ultrasound,TRUS）检查发现异常387例（59％）,超声造影检查异常表现385例（59％）.Logistic回归分析年龄、tPSA、fPSA/tPSA、PV、PSAD、直肠指检、TRUS和超声造影检查表现等指标对前列腺初次穿刺活检阳性的预测价值,绘制各项指标的受试者工作特征（receiver-operating characteristic,ROC）曲线,计算曲线下面积.Fisher二分类法逐步判别分析临床指标对穿刺结果的预测价值.结果 本组患者初次穿刺阳性率为48％ （314/658）.单因素分析结果显示年龄、tPSA、fPSA/tPSA、PV、PSAD、直肠指检阳性、TRUS异常发现和超声造影异常表现都与前列腺初次穿刺活检阳性显著相关（P＜0.05）,ROC曲线下面积依次为0.667、0.758、0.270、0.335、0.837、0.809、0.720、0.802.超声造影的ROC曲线下面积大于TRUS的ROC曲线下面积（P＜0.05）,PSAD的预测准确性最高.多因素分析显示年龄、tPSA、fPSA/tPSA、PV、直肠指检阳性和超声造影异常表现具有独立预测价值（P＜0.05）.对以上指标共同预测的结果进行Fisher判别分析,准确率为87.8％.结论 年龄、tPSA、fPSA/tPSA、PV、直肠指检阳性和超声造影异常表现是预测前列腺初次穿刺活检阳性的独立因素,综合这些指标能显著提高预测前列腺初次穿刺活检结果的准确率。

Objective To investigate the value of clinical and laboratory factors in predicting the probability of positive initial prostate biopsy.Methods Data were retrospectively reviewed from 658 Chinese patients, who underwent initial prostate biopsies from January 2010 and December 2013.The medians（interquartiles） of age, PV, tPSA, fPSA/tPSA and PSAD were 69（64,75） years, 44.8（30.9, 65.8）ml, 15.1 （9.0,30.8） μg/L, 0.14（0.10,0.23） and 0.33（0.18,0.80）.The positive rates of DRE, TRUS and MFI were 49% （324/658）, 59% （387/658） and 59% （385/658） ,respectively.Univariate and multivariate Logistic regression analysis the value of factors, including age, tPSA, fPSA/tPSA, PV, PSAD, DRE, TRUS and MFI, in predicting the probability of positive initial prostate biopsy.The area under the receiver-operating characteristic （ROC）curve was evaluated.A stepwise discriminant function analysis was to examine the role of factors above in predicting probability of positive initial prostate biopsy.Results The percentage of positive initial prostate biopsy in our study was 48% （314/658）.Univariate analysis showed that age, tPSA, f/t ratio, PV, PSAD, positive DRE, abnormal TRUS echogenicity and aberrant MFI findings had statistically significant relationships with prostate cancer （P 〈0.05）.The areas under the ROC curve for age, tPSA, f/t ratio, PV, PSAD, DRE, TRUS echogenicity and MFI findings were 0.667、0.758、 0.270、0.335、0.837、0.809、0.720、0.802,respectively,which indicated that MFI was a significantly better predictor than TRUS （P 〈 0.05.The predicting accuracy of PSAD was highest among those factors.Multivariate analysis revealed that age, tPSA, f/t ratio, PV, positive DRE, aberrant MFI findings were predictive independently of positive prostate biopsy （P 〈 0.05）.A cross-validation discriminant analysis was conducted and 87.8% correct classification rate was obtained.Conclusions Age, tPSA, f/t ratio, PV, positive DRE and aberrant MFI findings are predictive independently factors of positive prostate biopsy.Combining the clinical data with laboratory data can significantly improve the accuracy of predicting the prostate cancer.