PSAD与PI-RADS V2.1评分在多灶性临床显著前列腺癌中的研究

Study of PSAD and PI-RADS V2.1 Score in Multifocal and Clinically Significant Prostate Cancer

目的探讨前列腺特异性抗原密度(PSAD)与PI-RADS V2.1评分及其联合对诊断多灶性临床显著前列腺癌(MF-csPCa)的预测价值。方法搜集因PSA升高疑诊前列腺癌(PCa)并行MRI检查的患者。最终纳入MF-csPCa患者67例(A组),B组78例:包括非临床显著癌3例、前列腺增生50例,前列腺炎25例,所有患者均行穿刺活检病理或术后病理证实。PI-RADS V2.1评分由两位主治及以上医师盲法独立完成,并根据指数肿瘤(IL,直径最大且评分最高)进行评分,结合MRI体积测量计算PSAD。比较A组与B组之间年龄、BMI、tPSA、fPSA/tPSA、PSAD、前列腺体积及PI-RADS V2.1评分的差异,并使用二分类Logistic回归对年龄、tPSA、PSAD、PI-RADS V2.1评分进行多因素分析,采用Spearman分析PSAD和PI-RADS V2.1评分与Gleason评分的相关性,利用ROC曲线评价PSAD和PI-RADS V2.1及两者联合对MF-csPCa的诊断效能,P<0.05为差异有统计学意义。结果单因素分析显示:tPSA值、PSAD值、fPSA/tPSA和PI-RADS V2.1评分在A组与B组间的差异均有统计学意义。多因素分析显示:PI-RADS V2.1与PSAD是MF-csPCa的预测指标。PSAD值与Gleason分级呈正相关,r_(s)=0.443;PI-RADS V2.1评分与Gleason分级呈正相关,r_(s)=0.359。PSAD的ROC曲线下面积(AUC)值为0.818,PI-RADS V2.1评分的AUC值为0.871,联合模型的AUC值为0.900。结论PI-RADS V2.1与PSAD可作为MF-csPCa的预测指标,PSAD及PI-RADS V2.1评分与Gleason分级均呈正相关,PI-RADS V2.1评分与PSAD联合应用对MF-csPCa的诊断效能优于两者单独应用。

Objective To investigate the predictive value of prostate specific antigen density(PSAD)and PI-RADS V2.1 score and their combination in the diagnosis of Multifocal and clinically significantProstate cancer(MF-csPca).Methods MRI and PSA tests were performed within one week in patients with suspected prostate cancer(Pca)in our hospital from January 2018 to May 2020 due to elevated PSA.Finally,67 patients with MF-csPca(group A)and 78 patients with Group B were included,including 3 patients with non-clinically significant cancer,50 patients with prostatic hyperplasia and 25 patients with prostatitis.All patients were pathologically confirmed by needle biopsy or postoperative pathology.PI-RADS V2.1 score was completed independently by blind method by 2 physicians or above.The score was based on the index tumor(IL,with the largest diameter and the highest score),and PSAD was calculated in combination with MRI volume measurement.The differences in age,BMI,tPSA,fPSA/tPSA,PSAD,prostatevolume,and PI-RADS V2.1 score between group A and Group B were compared.Multivariate analysis was performed on age,tPSA,PSAD,and PI-RADS V2.1 score by binary Logistic regression.Spearman was used to analyze the correlation between PSAD and PI-RADS V2.1 score and Gleason score.ROC curve was used to evaluate the diagnostic efficacy of PSAD,PI-RADS V2.1 and the combination of PSAD and PI-RADS V2.1 for MF-csPca,and P<0.05 was considered statistically significant.Results Univariate analysis showed that tPSAvalue,PSADvalue,fPSA/tPSA and PI-RADS V2.1 score were significantly different between group A and Group B.Multivariate analysis showed that PI-RADS V2.1 and PSAD were predictor_(s) of MF-csPca.PSAD was positively correlated with Gleason grade,r_(s)=0.443.PI-RADS V2.1 score was positively correlated with Gleason grading,r_(s)=0.359.The area under ROC curve(AUC)value of PSAD was 0.818,the AUC value of PI-RADS V2.1 score was 0.871,and the AUC value of the combined model was 0.900.Conclusion PI-RADS V2.1 and PSAD can be used as predictor_(s) of MF-csPca,PSAD and PI-RADS V2.1 score are positively correlated with Gleason grade,and combined application of PI-RADS V2.1 score and PSAD has a better diagnostic efficacy for MF-csPca than the two alone.