超声引导下经会阴与经直肠途径认知融合结合前列腺系统穿刺活检阳性率的比较及影响因素分析

Comparison of the diagnostic efficacy between transrectal and transperineal cognitive fusion combined systematic prostate biopsy

目的比较经直肠超声引导下经直肠认知融合靶向结合系统穿刺和经会阴认知融合靶向结合系统穿刺对疑似前列腺癌患者的阳性检出率,并分析影响阳性检出率的临床因素。方法回顾性分析青岛大学附属医院2019年5—11月收治的385例疑似前列腺癌患者的临床资料,所有患者均符合前列腺穿刺指征。所有患者均行经直肠超声引导下认知融合靶向结合系统穿刺,其中经直肠认知融合靶向结合系统穿刺(经直肠组)275例,经会阴认知融合靶向结合系统穿刺(经会阴组)110例。经直肠组年龄(70.7±7.3)(48~85)岁,PSA(55.12±116.96)(4.5~1000.0)ng/ml;前列腺体积(55.96±35.26)(11~209)ml。经会阴组年龄(69.2±8.4)(44~92)岁,PSA(63.41±315.34)(4.0~4883.0)ng/ml,前列腺体积(64.35±55.99)(12~719)ml,两组间比较差异均无统计学意义(P>0.05)。首先根据术前前列腺磁共振影像结合术中超声对可疑病灶靶向穿刺2~4针,然后行系统穿刺12针,比较两种前列腺穿刺方式的的前列腺癌检出率。采用单因素和多因素logistic回归分析影响前列腺癌检出率的临床因素。结果经直肠组和经会阴组的前列腺癌检出率分别为40.0%(121/275)和60.9%(67/110),差异有统计学意义(P=0.003);有临床意义前列腺癌(csPCa)检出率分别为36.7%(101/275)和54.6%(60/110),差异有统计学意义(P=0.001)。单因素和多因素logistic回归分析显示PSA(OR=1.025,P=0.001)和前列腺体积(OR=0.984,P=0.001)是两组活检前列腺癌检出率的独立影响因素,而年龄对经会阴组前列腺癌检出率的影响明显小于经直肠组(OR=0.037,P=0.238与OR=0.053,P=0.002)。结论经会阴认知融合靶向结合前列腺系统穿刺较经直肠认知融合靶向结合前列腺系统穿刺能更准确地检出前列腺癌,PSA和前列腺体积是前列腺癌检出率的独立影响因素。

Objective This study aimed to compare the detection efficacy of transrectal ultrasound-guided transrectal cognitive fusion targeted+systematic prostate biopsy and transperineal cognitive fusion targeted+systematic biopsy in patients with suspected prostate cancer(PCa).In addition,the relative clinical characteristics of PCa were evaluated.Methods A total of 385 patients with suspected prostate cancer in the affiliated hospital of Qingdao University from May 2019 to November 2019 were retrospectively analyzed.All patients met the prostate biopsy criterion,who underwent transrectal(n=275)and transperineal(n=110)prostate biopsy respectively.There were no significant differences of mean age[(70.7±7.3)years vs.(69.2±8.4)years],PSA[(55.12±116.96)ng/ml vs.(63.41±315.34)ng/ml],prostate volume[(55.96±35.26)ml vs.(64.35±55.99)ml]between two groups.According to preoperative prostate magnetic resonance imaging combined with intraoperative ultrasound,2-4 needles targeted puncture of suspected lesion were performed,followed by 12 needle systematic prostate biopsy.The detection rate of prostate cancer between two biopsy ways were compared.The related factors of PCa including age,prostate volume and PSA level were collected for univariable and multivariable logistic analysis.The cancer detection rate was compared and logistic regression was used to assess the impact of patient characteristics on PCa detection.Results For all patients,the detection rate with cancer between transrectal group and transperineal group were 121/275(40.0%)and 67/110(60.9%),respectively.The transperineal group detected a higher rate of PCa(P=0.003)and more clinically significant prostate cancers(csPCa)(54.6%vs.36.7%,P=0.001)than that of the transrectal group,there were significant differences between two groups(P<0.05).Univariate and multivariate logistic regression analysis revealed that PSA(OR=1.025,P=0.001)and prostate volume(OR=0.984,P=0.001)were two independent factors for the detection rate of prostate cancer between two biopsy ways(P<0.05).The effect of age on the detection rate of PCa in the transperieal group was significantly lower than that of the transrectal group(OR=0.037,P=0.238 vs.OR=0.053,P=0.002).Conclusion The transperieal biopsy could find more PCa than the transrectal biopsy.PSA level and prostate volume could affect the detection rate of cancer between two prostate biopsy ways.