前列腺穿刺活检≤2针阳性患者根治术后发生Gleason评分升高的危险因素分析

Risk factors of elevated postoperative Gleason score postoperative in patients with≤2 positive prostate biopsies

目的 探究超声引导下前列腺穿刺活检病理≤2针阳性患者行前列腺癌根治术(RP)后发生Gleason评分(GS)升高的相关危险因素。方法 回顾性分析2014年6月至2017年12月在西安交通大学第一附属医院泌尿外科行前列腺穿刺活检,病理诊断为≤2针阳性,且行RP的115例前列腺癌(PCa)患者的临床病理资料,采用单因素和多因素Logistic回归分析法筛选与RP后大体病理GS较术前穿刺升高的危险因素,通过受试者工作特征(ROC)曲线下面积(AUC)检验预测效能。结果 115例患者术后大体标本病理GS与术前穿刺病理相同或降低者66(57.39%)例,较术前升高者49(42.61%)例。单因素分析显示,前列腺体积(PV)、穿刺针数、穿刺阳性针数和穿刺GS差异具有统计学意义(P<0.05),将其纳入多因素Logistic回归分析,结果显示PV小(P<0.001)和穿刺阳性针数为1针(P=0.013)是RP后大体病理GS升高的独立危险因素。由PV和穿刺阳性针数预测术后GS升高的AUC为0.880,提示预测效能较好。结论 前列腺穿刺活检≤2针阳性的患者RP后病理GS较术前穿刺存在升高现象,PV较小和穿刺阳性针数为1针为其独立危险因素。

Objective To investigate the risk factors associated with elevated Gleason score(GS)after radical prostatectomy(RP)for prostate cancer(PCa)in patients with≤2 ultrasound-guided prostate biopsies.Methods The clinicopathological data of 115 PCa patients who underwent prostate biopsy during Jun.2014 and Dec.2017 at the Department of Urology of the First Affiliated Hospital of Xi an Jiaotong University with a pathological diagnosis of≤2 needle positivity and underwent RP were retrospectively analyzed.Risk factors associated with elevated GS were screened with univariate analysis and multivariate Logistic regression analysis.The predictive efficacy was verified with the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results The postoperative GS remained the same or decreased in 66(57.39%)cases,and increased in 49(42.61%)cases.Univariate analysis showed prostate volume(PV),number of puncture needles,number of positive needles and GS were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that small PV(P<0.001)and the number of positive needles being 1(P=0.013)were independent risk factors of elevated GS after RP.The AUC was 0.880,suggesting good predictive efficacy.Conclusion Patients with≤2 positive biopsies tend to have elevated GS after RP,and small PV and 1 positive needle are the independent risk factors.