PSAD对临床低危前列腺癌患者RP术后Gleason评分的预测价值

Value of prostate-specific antigen density to predict risk level of prostate cancer

目的探讨前列腺特异性抗原密度(PSAD)对临床低危前列腺癌(PCa)患者根治性前列腺切除术(RP)后Gleason评分的预测价值。方法回顾性分析102例经首次前列腺活检(PB)确诊且行RP术的临床低危PCa患者的临床资料(PSA<10μg/L,临床分期≤T_(2a),Gleason评分≤6分)。根据RP术后Gleason评分是否升高分为评分一致组48例与评分升高组54例,比较两组患者的临床资料;绘制ROC曲线并计算AUC,以确定PSAD预测RP术后Gleason评分升高的效能。结果评分升高组PSAD为0.310(0.190,0.408)mg/L^2,明显高于评分一致组的0.181(0.142,0.248)mg/L^2(P<0.01);评分升高组PV为24.107(18.252,30.208)ml,明显小于评分一致组的30.129(22.617,40.538)ml(P<0.05);评分升高组病理分期、侵犯包膜阳性率均高于评分一致组(均P<0.01)。AUC为0.734(95%CI:0.636~0.832),PSAD预测首次PB时Gleason评分升高的截值为0.263mg/L^2,其灵敏度和特异度分别为63.0%和85.4%。结论 PB确诊为临床低危PCa患者中,PSAD对RP术后Gleason真实评分具有较好的预测价值。

Objective To evaluate the application of PSAD in prediction of Gleason score in patients with low risk prostate cancers（PCa） after radical prostatectomy（RP）. Methods Clinical data of 102 PCa patients with low risk（PSA〈10μg/L, stage≤T2a, Gleason score≤6） who underwent preoperative biopsy and RP were retrospectively analyzed. Receiver operating characteristic（ROC） curves of PSAD for predicting rising Gleason scores were generated, and the area under the curve（AUC） was calculated.Results Among 102 patients, 54（52.9%） had risen Gleason score after operation. PSAD was significantly higher in patients with risen Gleason score after RP than that in patients with Gleason score not changed（0.310mg/L^2 vs 0.181mg/L^2, P=0.000）. The pathologic stages in patients with risen Gleason were more advanced（P=0.000）. The AUC of ROC was 0.734（95%CI： 0.636-0.832）.Taking 0.263mg/L^2 as cut-off value, the sensitivity and specificity of PSAD in predicting Gleason score rising were 63.0% and85.4%, respectively. Conclusion PSAD has the value of predicting Gleason score rising after RP in PCa patients with low clinical risk.