PCPT-RC高风险概率联合Gleason评分对初诊前列腺癌转移风险的预测价值

The value of PCPT-RC high risk probability combined with Gleason score for predicting the risk of metastasis in newly diagnosed prostate cancer

目的探讨前列腺癌预防试验风险计算器(PCPT-RC)联合活体组织穿刺病理Gleason评分对初诊前列腺癌患者转移风险的预测价值。方法回顾性收集2019年4月至2021年8月经前列腺穿刺活检病理证实为前列腺癌,并行18F-PSMA-1007 PET/CT检查的74例初诊患者的影像、病理及临床资料。以此为基础,建立二元Logistic回归模型,获得PCPT高风险概率,绘制受试者特征工作曲线(ROC),计算曲线下面积、约登指数、敏感性、特异性、阳性预测值、阴性预测值,比较单独或联合应用PCPT-RC及Gleason评分对前列腺癌转移风险的预测价值。结果以PSMA PET/CT成像结果为标准,将74例初诊前列腺癌患者分为无转移组(46例)和转移组(28例)。转移组PCPT高风险概率[41.14%(16%~67%)]vs.[30.89%(5%~65%)]、Gleason评分[8.5(6~10)分]vs.[7.7(6~9)分]、tPSA[26.24(5.70~42.32)ng/mL]vs.[19.58(2.47~49.35)ng/mL]及fPSA[3.94(0.82~12.00)ng/mL]vs.[2.33(0.35~10.20)ng/mL]均高于无转移组,差异有统计学意义。由二元Logistic回归结果得到PCPT高风险概率、Gleason评分及PCPT阴性概率可能是影响前列腺癌发生转移的独立预测因子。单独用PCPT阴性概率不能预测前列腺癌转移(P=0.172),单独用Gleason评分和PCPT高风险概率预测前列腺癌转移的准确性分别为0.715和0.679,二者联合预测的准确性提高至0.809。结论PCPT-RC高风险概率联合Gleason评分对初诊前列腺癌患者转移风险有较好的预测价值,对临床个体化治疗有一定的指导意义。

Objective To investigate the value of prostate cancer prevention trial risk calculator(PCPT-RC)combined with biopsy Gleason score for predicting the risk of metastasis in newly diagnosed prostate cancer patients.Methods We retrospectively collected the data of 74 patients with newly diagnosed prostate cancer confirmed by biopsy from April 2019 to August 2021,concurrent with18 F-PSMA-1007 PET/CT whole body imaging in the same period.Based on this,a binary logistic regression model was established to obtain the high risk probability of PCPT.We calculated the receiver operating characteristic curve(ROC)was drawn and the area under the curve,Yuden index,sensitivity,specificity,positive predictive value and negative predictive value.We compared the predictive value of the prostate cancer prevention trial risk calculator and Gleason score alone or in combination in predicting the risk of prostate cancer metastasis.Results Based on the PSMA PET/CT results,74 patients were divided into non-metastatic group(46/74)and metastatic group(28/74).PCPT high risk probability[41.14%(16%-67%)]vs.[30.89%(5%-65%)],Gleason score[8.5(6-10)score]vs.[7.7(6-9)score],tPSA[26.24(5.70-42.32)ng/mL]vs.[19.58(2.47-49.35)ng/mL],and fPSA[3.94(0.82-12.00)ng/mL]vs.[2.33(0.35-10.20)ng/mL]were significantly higher in metastatic group than in non-metastatic group.Binary Logistic regression analysis showed that Gleason score and PCPT low risk probability may be independent predictors of prostate cancer metastasis.PCPT low risk probability alone did not predict the risk of prostate cancer metastasis(P=0.172).The predictive accuracy of Gleason score and high probability of PCPT in predicting prostate cancer metastasis were 0.715 and 0.679,respectively,and the accuracy of the combined prediction was 0.809.Conclusion PCPT-RC combined with Gleason score is valuable for predicting the metastasis risk of newly diagnosed prostate cancer patients,which has certain guiding significance for clinical individualized treatment.