2型糖尿病患者预警前列腺癌的前列腺特异性抗原新阈值的设定

Setting of the new threshold of prostate-specific antigen for early warning of prostate cancer in type 2 diabetes mellitus

目的:建立2型糖尿病(T2DM)人群中预警前列腺癌(PCa)的前列腺特异性抗原(PSA)新阈值。方法:回顾性分析2012年1月至2018年12月上海市第十人民医院收治的2151例初次行前列腺穿刺活检术患者的临床资料。以前列腺穿刺活检病理结果阳性为金标准,将所有患者分为T2DM组和非T2DM组进行比较,其中合并PCa的患者分为PCa-T2DM组和PCa-非T2DM组。采用大数据分析与机器学习的方法,得到T2DM人群中预警PCa的PSA新阈值(原阈值4.0 ng/ml),计算其灵敏度、特异度。采用概率函数拟合估算总体人群中PSA水平的分布情况,支持向量机计算新阈值,受试者工作特征(ROC)曲线用于检验其诊断效能。结果:2151例患者的PCa检出率为35.89%(772/2151)。将所有受试者分为T2DM组496例(23.06%)和非T2DM组1655例(76.94%)。T2DM组患者的PSA低于非T2DM组,差异均有统计学意义(P<0.01)。针对T2DM人群筛查PCa的PSA新阈值为3.27 ng/ml。T2DM组以PSA=3.27 ng/ml作为诊断截点,ROC曲线下面积为0.83,诊断的灵敏度和特异度分别为94.53%和41.36%。全部人群以PSA=4 ng/ml作为诊断截点,ROC曲线下面积为0.83,灵敏度和特异度分别为91.54%和46.78%。两组比较差异无统计学意义(P>0.05)。结论:T2DM患者PSA水平降低,针对T2DM人群的PSA新阈值(3.27 ng/ml)具有较好的前列腺癌预警作用,有利于提高T2DM患者前列腺癌的早期诊断率。

Objective To establish a new threshold of prostate-specific antigen(PSA)for early warning of prostate cancer(PCa)among people with type 2 diabetes mellitus(T2DM).Methods We retrospectively analyzed the clinical data of 2151 patients who underwent prostate biopsy for the first time admitted to Shanghai Tenth People′s Hospital from January 2012 to December 2018.Taking the positive pathological results of prostate biopsy as the gold standard,all patients were divided into T2DM group and non-T2DM group for comparison.Among them,patients with PCa were divided into PCa-T2DM group and PCa-non-T2DM group.Using the method of big data analysis and machine learning,a new PSA threshold for early warning of PCa in the T2DM population(the original threshold 4.0 ng/ml)was obtained,and its sensitivity and specificity were calculated.Probability function fitting was used to estimate the distribution of PSA levels in the overall population,support vector machine was used to calculate the new threshold,and receiver operating characteristic(ROC)curve was used to test its diagnostic efficacy.Results The detection rate of PCa in 2151 patients was 35.89%(772/2151).All subjects were divided into T2DM group(496 cases,23.06%)and non-T2DM group(1655 cases,76.94%).The PSA of the T2DM group was lower than that of the non-T2DM group,and the difference was statistically significant(P<0.01).The new PSA threshold for PCa screening for T2DM population was 3.27 ng/ml.In the T2DM group,with 3.27 ng/ml of PSA as the diagnostic cut-off point,the area under the ROC curve was 0.83,and the diagnostic sensitivity and specificity were 94.53%and 41.36%,respectively.In the overall population,with 4 ng/ml of PSA as the diagnostic cut-off point,the area under the ROC curve was 0.83,and the sensitivity and specificity were 91.54%and 46.78%,respectively.There was no statistically significant difference between the two groups(P>0.05).Conclusions The serum PSA levels in T2DM patients reduced.The new PSA threshold(3.27 ng/ml)for type 2 diabetes mellitus has a better early warning effect on prostate cancer,which is conducive to improving the early diagnosis rate of prostate cancer in T2DM patients.