血清TPSA、FPSA水平及其比值对前列腺癌的诊断价值及其与根治术后生化复发的相关性分析

Level of TPSA,FPSA and Their Ratio in the Diagnosis of Prostate Cancer and Their Correlation with Biochemical Recurrence After Radical Prostatectomy

目的探讨血清总前列腺特异抗原、血清游离前列腺特异抗原水平及其比值对前列腺癌的诊断价值及其与根治术后生化复发的相关性。方法选择前列腺癌患者(均行前列腺癌根治术)113例作为癌症组,前列腺增生患者100例作为增生组,选择同期体检健康者78例作为对照组。检测癌症组术前、增生组、对照组的血清TPSA、FPSA水平,并计算FPSA/TPSA值,分析TPSA、FPSA、FPSA/TPSA对前列腺癌的诊断价值;对113例前列腺癌患者根据术后是否发生生化复发分为生化复发组(31例)和非生化复发组(82例),收集并比较两组临床病理因素资料,采用Logstic回归分析其与前列腺癌根治术后生化复发的相关性。结果癌症组血清TPSA、FPSA水平显著高于增生组和对照组,增生组高于对照组,以及FPSA/TPSA值显著低于增生组和对照组,增生组低于对照组(P<0.05);受试者工作特征曲线结果表明,TPSA、TPSA、FPSA/TPSA对前列腺癌诊断有较好的敏感性和特异性;两组患者年龄、体重指数差异无统计学差异(P>0.05),生化复发组精囊侵犯阳性率、切缘阳性率、T2/T3分期阳性率、Gleason评分、血清TPSA和FPSA水平以及FPSA/TPSA值显著高于非生化复发组(P<0.05);Logstic回归分析得出,精囊侵犯、切缘阳性、病理分期加重、高Gleason评分、高水平TPSA和FPSA、低FPSA/TPSA比值是前列腺癌根治术后生化复发的高风险因素。结论前列腺癌患者血清TPSA、FPSA水平显著升高,FPSA/TPSA比值显著降低,血清TPSA、FPSA水平检测联合FPSA/TPSA比值对前列腺癌有较高的诊断价值,可作为临床前列腺癌筛查方式,同时血清TPSA、FPSA水平升高及FPSA/TPSA比值降低也是前列腺根治术后生化复发的高风险因素。

Objective To investigate the diagnostic value of serum total prostate-specific antigen(TPSA)and serum free prostate-specific antigen(FPSA)levels for prostate cancer and their correlation with biochemical recurrence after radical resection.Methods 113 patients with prostate cancer(all underwent radical prostatectomy)were selected as the cancer group,100 patients with benign prostatic hyperplasia were selected as the hyperplasia group,and 78 healthy people in the same period were selected as the control group.The serum levels of TPSA and FPSA were detected in the cancer group,hyperplasia group and control group before operation,and the FPSA/TPSA values were calculated to analyze the diagnostic value of TPSA,FPSA and FPSA/TPSA for prostate cancer;113 patients with prostate cancer were divided into biochemical recurrence group(31 cases)and non biochemical recurrence group(82 cases)according to whether biochemical recurrence occurred after surgery.The clinicopathological factors of the 2 groups were collected and compared,and the correlation between biochemical recurrence after radical prostatectomy and biochemical recurrence was analyzed by logistic regression.Results The levels of serum TPSA and FPSA in the cancer group were significantly higher than those in the hyperplasia group and the control group,the hyperplasia group was higher than that in the control group,and the fpsa/tpsa value was significantly lower than that in the hyperplasia group and the control group,and the hyperplasia group was lower than that in the control group(P<0.05);ROC results showed that TPSA,TPSA,fPSA/TPSA had good sensitivity and specificity for the diagnosis of prostate cancer;There was no significant difference in age and body mass index between the 2 groups(P>0.05).The positive rate of seminal vesicle invasion,positive rate of resection margin,positive rate of t2/t3 stage,Gleason score,serum TPSA and FPSA levels,and fpsa/tpsa value in the biochemical recurrence group were significantly higher than those in the non biochemical recurrence group(P<0.05);Logistic regression analysis showed that semi-nal vesicle invasion,positive resection margin,aggravated pathological stage,high Gleason score,high levels of TPSA and FPSA,and low fpsa/tpsa ratio were high risk factors for biochemical recurrence after radical prostatectomy.Conclusion The levels of serum TPSA and FPSA in patients with prostate cancer were significantly increased,and the FPSA/TPSA ratio was significantly decreased.The detection of serum TPSA and FPSA levels combined with FPSA/TPSA ratio has high diagnostic value for prostate cancer,and can be used as a clinical screening method for prostate cancer.At the same time,the increase of serum TPSA and FPSA levels and the decrease of FPSA/TPSA ratio are also high risk factors for biochemical recurrence after radical prostatectomy.