血清p2PSA检测在前列腺癌诊断中的临床应用价值

Clinical value of serum p2PSA detection in the diagnosis of prostate cancer

目的评价前列腺特异性抗原(PSA)水平稍高的病例中,PSA同源异构体2(p2PSA)和百分p2PSA(p2PSA)检测对前列腺癌(PCa)诊断的临床应用价值。方法采用病例对照研究法筛选2017年10月至2018年11月于我院就诊,且总PCa(tPCa)水平为4.0~20.0μg/L并接受了经直肠超声引导前列腺穿刺活检的男性患者150例,收集其临床资料。其中经病理检查结果证实PCa患者58例、非PCa患者92例,将所有患者依据tPSA水平分为LtPSA组(tPSA 4.0~10.0μg/L)和HtPSA组(tPSA 10.1~10.0μg/L),根据受试者工作特征曲线(ROC)评价各血清标志物对PSa的诊断效能。结果LtPSA组内PCa与非PCa癌患者间,tPSA、游离PSA(fPSA)、p2PSA差异无统计学意义(P>0.05),%p2PSA值前者明显高于后者,差异有统计学意义(P<0.05);HtPSA组内PCa与非PCa患者间,tPSA、fPSA差异无统计学意义(P>0.05),p2PSA、p2PSA值前者明显高于后者,差异有统计学意义(P<0.05)。LtPSA组内各血清标志物诊断PCa的ROC曲线下面积(AUC)依次为p2PSA>tPSA>p2PSA>fPSA,且仅有%p2PSA的AUC>0.75;HtPSA组内各血清标志物诊断PCa的AUC依次为%p2PSA>p2PSA>tPSA>fPSA,且%p2PSA、p2PSA的AUC均>0.75。结论在PSA水平稍高的病例中,血清p2PSA和%p2PSA与tPSA和fPSA相比,具有更高的肿瘤特异性,提升了PCa的诊断准确性,更适合作为PCa的辅助诊断参考指标。

Objective To evaluate the clinical value of detection of prostate-specific antigen isoform 2(p2PSA)and percentage of p2PSA(%p2PSA)in the diagnosis of prostate cancer(PCa)in patients with slightly higher serum prostate specific antigen(PSA)level.Mothods Case-control study was used in this study.From October 2017 to November 2018,150 male patients with total prostate specific antigen(tPSA)level ranging from 4.0-20.0μg/L who underwent transrectal ultrasound-guided prostate biopsy were selected to collect serum and clinical data.In this study,58 patients PCa and 92 patients with non-PCa were diagnosed according to the pathological results.All patients were divided into tPSA 4.0-10.0μg/L group(LtPSA)and tPSA 10.1-20.0μg/L group(HtPSA)according to the level of tPSA.The diagnostic efficacy of serum markers for PCa was evaluated according to receiver operating characteristic curve(ROC).Results There was no significant difference in tPSA,fPSA and p2PSA between PCa and non-PCa in LtPSA group(P>0.05),but the%p2PSA of the former group was significantly higher than that of the latter group(P<0.05).There was no significant difference in tPSA or fPSA between PCa and non-PCa in HtPSA group(P>0.05),but the p2PSA and%p2PSA of the former group were significantly higher than those of the latter group(P<0.05).The ROC-AUC for diagnosing PCa with serum markers in LtPSA group was%p2PSA>tPSA>p2PSA>fPSA,and only the AUC of%p2PSA>0.75.The ROC of serum markers for PCa diagnosis in HtPSA group showed that AUC%p2PSA>p2PSA>tPSA>fPSA,and the AUC of%p2PSA and p2PSA were>0.75.Conclusions Compared with tPSA and fPSA,serum p2PSA and p2PSA have higher tumor specificity in patients with slightly higher PSA level,which improves the diagnostic accuracy of PCa and is more suitable as a reference index for assistant diagnosis of PCa.