前列腺癌患者根治术后病理Gleason评分升高预测因素研究

发布时间：2018-01-13 11:43

  本文关键词：前列腺癌患者根治术后病理Gleason评分升高预测因素研究　出处：《第三军医大学学报》2016年24期 　论文类型：期刊论文

  更多相关文章： 前列腺癌 Gleason评分 前列腺活检 前列腺特异性抗原密度

【摘要】：目的探讨经直肠前列腺穿刺活检的中低危前列腺癌患者术后发生病理Gleason评分升高的预测因素。方法收集2005年1月至2016年5月于我院泌尿外科接受前列腺穿刺活检并行前列腺癌根治手术的123例中低危前列腺癌患者的临床资料,回顾性分析术后发生Gleason评分升高与患者年龄、术前血清总前列腺特异抗原(total prostate specific antigen,t PSA)、术前血清游离PSA(f PSA)/t PSA、前列腺体积、前列腺特异性抗原密度(PSAD)、穿刺阳性针数比、切缘阳性率、穿刺评分等级、临床分期等的关系,进一步分析其预测价值。结果 123例患者中经直肠超声(transrectal ultrasonography,TRUS)引导下前列腺穿刺活检病理Gleason评分与前列腺癌根治术后病理Gleason评分保持一致66例(53.7%),评分下降10例(8.1%),评分升高47例(38.2%)。前列腺体积、PSAD及穿刺活检病理Gleason评分等级与术后发生病理Gleason评分升高有关(P0.05)。进一步Logistic回归分析结果显示仅PSAD(P=0.01)与穿刺活检病理Gleason评分等级(P=0.03)是前列腺癌根治术后病理Gleason评分升高的独立预测因子。应用受试者工作特征(receiver operating characteristic,ROC)曲线分析得出:前列腺穿刺活检病理Gleason评分等级=7的患者,PSAD0.282 ng/(m L·g)时,根治术后发生具有临床意义的Gleason评分升高的可能性大(敏感性78.2%,特异性70.4%);而前列腺穿刺活检病理Gleason评分等级≤6的患者,PSAD0.265 ng/(m L·g)时,根治术后发生具有临床意义的Gleason评分升高的可能性大(敏感性77.1%,特异性68.0%)。结论 PSAD与穿刺评分等级是根治术后病理Gleason评分升高的独立预测因子。PSAD与前列腺癌患者术后发生病理Gleason评分升高密切相关。
[Abstract]:Objective to investigate the prognostic factors of the increase of pathological Gleason score in patients with low and middle risk prostate cancer after transrectal prostate biopsy. Methods from January 2005 to May 2016, the patients were collected in our hospital. Clinical data of 123 patients with low and middle risk prostate cancer who underwent prostate biopsy and radical prostatectomy in urology. The Gleason score was increased and the age of the patients was analyzed retrospectively. Serum total prostate specific antigent PSAs before operation. Preoperative serum free PSA(f PSA)/t, prostate volume, prostate specific antigen density, the number of positive needle puncture, the positive rate of incision margin, the grade of puncture score. Results Transrectal ultrasonography was performed in 123 patients with transrectal ultrasound. The Gleason score of prostate biopsy guided by trust was consistent with that of Gleason after radical prostatectomy in 66 cases (53.7%). The score decreased in 10 cases and increased in 47 cases. The volume of prostate was increased in 47 cases. The grade of PSAD and pathological Gleason score of puncture biopsy was related to the increase of postoperative pathological Gleason score (P0.05). The results of further Logistic regression analysis showed that only PSAD P0. 01) and biopsy pathological Gleason grade were P0. 03). It is an independent predictor of the increase of pathological Gleason score after radical prostatectomy. Receiver operating characteristic. Roc curve analysis showed that PSAD 0.282 ng/(m / L 路g was found in the patients with Gleason grade 7 of prostate biopsy. The possibility of clinical Gleason score increase after radical operation is high (sensitivity 78.2, specificity 70.4); However, PSAD was 0.265 ng/(m L 路g in patients with Gleason score 鈮，

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