外周血生物标志物在前列腺癌鉴别诊断中的作用及对恶性程度评判价值

The Application of Peripheral Blood Biomarkers in the Differential Diagnosis of Prostate Cancer and Its Value to Evaluate Malignancy

目的探讨外周血生物标志物或联合检测对前列腺癌鉴别诊断的作用,并分析标志物在前列癌不同恶性程度间的差异性。方法回顾性分析2015年1月至2016年12月于中国医学科学院肿瘤医院就诊的126例前列腺癌(prostate cancer,PCa)患者和34例前列腺增生(benign prostatic hyperplasia,BPH)患者的临床资料,应用Logistic回归和受试者工作特征曲线(ROC)分析前列腺疾病患者的外周血生物标志物或多指标联合分析对前列腺癌鉴别诊断的价值。按照前列腺癌恶性程度分组对各指标进行差异分析。结果绘制各指标用于鉴别前列腺癌和前列腺增生的ROC结果显示总前列腺特异抗原(tPSA)和游离/总前列腺特异抗原(fPSA/tPSA)及血小板/淋巴细胞(PLR)的曲线下面积(AUC)最大。Logistic回归和ROC曲线分析结果提示:tPSA和fPSA/tPSA联合分析诊断效能最佳(AUC为0.76),联合PLR不能提高tPSA和fPSA/tPSA对前列腺癌鉴别诊断效能。前列腺癌不同恶性程度组间差异性分析结果显示:在126例前列癌患者中,外周血PLR和中性粒/淋巴细胞(NLR)在不同tPSA及临床分期间存在组间差异(P<0.05),乳酸脱氢酶(LDH)在前列腺癌不同恶性程度分组间未见明显差异。结论外周血生物标志物tPSA和fPSA/tPSA联合分析对前列腺癌鉴别诊断价值最大,外周血PLR和NLR可辅助tPSA、Gleason评分和临床分期评估前列腺癌的恶性程度,对前列腺癌恶性程度评判具有一定的提示作用。

Objective This study aimed to evaluate the difference of the application of peripheral blood biomarkers in the differential diagnosis of prostate cancer. Methods Clinical data of 126 patients with prostate cancer （PCa） and 34 patients with benign prostatic hyperplasia （BPH） in National Cancer Hospital between January 2015 and December 2016 was retrospectively collected. Logistic regression and ROC curves were used to explore the diagnostic value of markers in peripheral blood. The differences of markers were analyzed according to the malignant degree of prostate cancer. Results The results of ROC curve to distinguish BPH and PCa showed showed that the AUC of tPSA, fPSA/tPSA and PLR were the largest. The results of Logistic regression and ROC curve analysis of combined markers showed that the diagnostic efficiency of tPSA and fPSA/tPSA combined analysis was the best with AUC = 0. 76. Comparisons among different degrees of malignant groups in 126 patients with PCa,PLR and NLR in peripheral blood showed significant differences among different tPSA and clinical classifications （ P 〈 0.05 ）. There was no significant difference in LDH among different degree of malignant groups. Conclusion Our results suggested that combined-analysis of tPSA and fPSA/tPSA had the best diagnostic efficiency for BPH and PCa. PLR and NLR in peripheral blood can assist tPSA, Gleason scoring and clinical staging to assess the malignancy of prostate cancer and have potenialpositive effects on evaluating malignancy.