Gleason7分前列腺癌患者术后病理降级风险列线图预测模型的建立

Establishment of a nomogram model for predicting the risk of postoperative pathological degradation in patients with gleason7 prostate cancer

目的:探讨Gleason7分前列腺癌患者进行根治术后发生病理降级的预测因素,并建立列线图预测模型。方法:以2018年1月~2020年12月在我院泌尿外科就诊的180例病理活检Gleason评分为7分(3+4)的前列腺癌患者的临床资料为研究对象,根据术后是否发生病理降级分为降级组(54例)和非降级组(126例)。比较两组临床资料,分别进行单因素和多因素Logistic回归分析获得独立预测因素并建立列线图预测模型,并采用ROC曲线图评价上述模型的预测价值。结果:降级组与非降级组前列腺影响报告和数据系统评分(prostate imaging reporting and data system,PI-RADS)、切缘阳性、穿刺阳性针数、穿刺阳性针数百分比、血清前列腺特异性抗原(prostate-specificantigen,PSA)、前列腺体积(prostate volume,PV)、PSA密度(PSA density,PSAD)、MRI表观弥散系数(ADC)熵值差异有统计学意义(P<0.05),在临床T分期、穿刺方式、手术方式、精囊侵犯、平均年龄、身体质量指数(BMI)、游离PSA(free PSA,fPSA)、游离PSA/血清PSA(f/t)、移行区体积、移行区指数、ADC均值、ADC峰度上差异均无统计学意义(P>0.05)。单因素分析表明PI-RADS评分、切缘阳性、穿刺阳性针数、穿刺阳性针数百分比、PSA、PV、PSAD、ADC熵值是前列腺癌术后病理降级的潜在预测因素(P<0.05),多因素分析表明穿刺阳性针数百分比、PSA、PV、ADC熵值是前列腺癌术后病理降级的独立预测因素(P<0.05)。列线图模型对术后病理降级的预测作用的ROC曲线下面积为0.882(95%CI:0.842:~0.923,敏感度83.33%,特异度78.57%。结论:穿刺阳性针数百分比、PSA、PV、ADC熵值是前列腺癌术后病理降级的独立预测因素,该列线图模型对术后病理降级具有较高的预测价值,可以为前列腺癌患者临床治疗策略的制定提供参考。

The clinical data of 180 prostate cancer patients with pathological biopsy Gleason score of 7(3+4)in the department of urology of Xingtai third hospital from January 2018 to December 2020 were taken as the research object.The patients were divided into degradation group(54 cases)and non degradation group(126cases)according to whether there was pathological degradation after operation.The clinical data of the two groups were compared,and the independent predictors were obtained by univariate and multivariate logistic regression analysis.The nomogram prediction model was established,and the ROC curve was used to evaluate the prediction value of the above model.Prostate impact reporting and data system score(PI-RADS),positive margin,number of puncture positive needles,percentage of puncture positive needles,serum prostate specific antigen(PSA),prostate volume(PV),PSA density(PSAD)and MRI apparent diffusion coefficient of the two groups showed significant difference in entropy(ADC)(P<0.05).The clinical T stage,puncture mode,operation mode,seminal vesicle invasion,mean age,body mass index(BMI),free PSA(FPSA),free PSA/serum PSA(f/t),transitional area volume,transitional area index,ADC mean value and ADC kurtosis(P>0.05)of the two groups showed no significant difference(P>0.05).Univariate analysis showed that clinical T stage,PI-RADS score,positive margin,number of puncture positive needles,percentage of puncture positive needles,PSA,PV,PSAD and ADC entropy were potential predictors of postoperative pathological degradation of prostate cancer(P<0.05).Multivariate analysis showed that the percentage of puncture positive needles,PSA,PV and ADC entropy were independent predictors of postoperative pathological degradation of prostate cancer(P<0.05).The area under ROC curve of nomogram model in predicting postoperative pathological degradation was 0.882(95%CI:0.842:—0.923),with sensitivity of 83.33%and specificity of 78.57%.The study indicates that percentage of puncture positive needles,PSA,PV and ADC entropy are independent predictors of postoperative pathological degradation of prostate cancer.The nomogram model has high predictive value for postoperative pathological degradation.