术前不同PHI水平对前列腺癌诊断及生化复发的影响分析

The influence of different preoperative PHI levels on the diagnosis and biochemical recurrence of prostate cancer

探讨前列腺特异性抗原同源异构体2(p2PSA)和前列腺健康指数(PHI)对前列腺癌(PCA)诊断的意义,并进一步研究不同水平的术前PHI对PCA生化复发(BCR)的影响。经病理证实的38例PCA和69例良性前列腺增生(BPH)的p2PSA、总前列腺特异性抗原(tPSA),游离前列腺特异性抗原(fPSA),采用受试者工作特征(ROC)曲线下的面积(AUC),评价各项指标诊断PCA的价值。随访术后PCA患者12个月的BCR情况,利用ROC曲线确定PHI的最佳截止值,并将患者分为低PHI组和高PHI组,比较两组的BCR复发率及术前不同水平PHI对术后BCR的影响。对于PSA>4 ng/ml的BPH与PCA患者中,PCA组年龄、tPSA、fPSA、p2PSA和PHI的水平与均高于BPH组,差异有统计学意义(P<0.05)。ROC曲线分析显示,tPSA、p2PSA和PHI诊断PCA的AUC分别为0.637(95%CI:0.529~0.745)、0.731(95%CI:0.630~0.833)、0.845(95%CI:0.770~0.920)。PHI、p2PSA的AUC高于tPSA的AUC,具有更高的诊断价值(AUC>0.7)。高PHI组随访12个月的BCR高于低PHI组,差异有统计学意义(P=0.015)。PHI在PCA的诊断的价值优于目前临床常用的tPSA和fPSA,PHI=71.28可能作为评估PCA术后BCR的临界值,可作为PCA的诊断及术前预测BCR的指标应用于临床。

To investigate the role of prostate-specifific antigen isoform 2(p2PSA)and its related marker prostate health index(PHI)in the diagnosis of prostate cancer,and to further study the effect of different levels of preoperative PHI on the biochemical recurrence(BCR)of prostate cancer.Serum p2PSA,total prostate specifific antigen(tPSA)and free prostate specifific antigen(fPSA)were determined in 38 patients with prostate cancer and 69 patients with benign prostatic hyperplasia(BPH)confirmed by pathology.The BCR of PCA patients after 12 months was followed up.The optimal cutoff value of PHI was determined by using the ROC curve.The patients were divided into low PHI(PHI≤71.28)and high PHI(PHI>71.28)groups.The recurrence rate of BCR and the effect of different levels of PHI on BCR after surgery was compared.Age,tPSA,fPSA,p2PSA and PHI between prostate cancer group and BPH group had significant statistical differences(P<0.05).ROC curve analysis showed that the areas under curves(AUC)of tPSA,p2PSA,f-PSA and PHI in the diagnosis of prostate cancer were 0.637(95%CI:0.529~0.745),0.731(95%CI:0.630~0.833)and 0.845(95%CI:0.770~0.920)respectively.The diagnostic efficacy of PHI and p2PSA in prostate cancer was better than that of fPSA,which had higher diagnostic value(AUC>0.7).The results showed that the biochemical recurrence of high PHI group was significantly higher than that of low PHI group after 12 months of follow-up,and the difference was statistically significant(P=0.015).The diagnostic efficacy of PHI for prostate cancer is better than those of tPSA and fPSA,which can be used as an auxiliary diagnostic method for prostate cancer.The PHI=71.28 might be the critical value for evaluating the biochemical recurrence rate of prostate cancer and it provides some valuable references for predicting the biochemical recurrence rate of prostate cancer before operation.