前列腺癌根治术后PSA异常的影响因素

发布时间：2018-01-31 08:01

  本文关键词： 前列腺癌 根治术 PSA异常 影响因素　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：分析前列腺癌根治术后PSA异常的临床相关因素，为前列腺癌患者个体化后续治疗提供依据。 方法：采用回顾性分析方法，对2004年1月-2013年10月期间在广西医科大学第一附属医院及附属肿瘤医院行前列腺癌根治术的72例前列腺癌患者的临床资料进行分析，观察患者的年龄、血清总前列腺特异性抗原水平(tPSA)、前列腺体积、直肠指检、影像学表现、新辅助治疗、穿刺Gleason评分、术后Gleason评分、临床分期、病理分期、淋巴结转移及手术切缘情况对术后PSA值的影响。统计学方法：样本均数比较采用t检验，百分数比较采用卡方检验,采用二元Logistic回归进行多因素分析。 结果:1.单因素分析显示年龄、前列腺体积、直肠指检、影像学表现、穿刺Gleason评分及临床分期对术后PSA值的差异无统计学意义（P0.1）。2.新辅助治疗、术前tPSA、病理分期、术后Gleason评分、淋巴结转移及切缘情况对术后PSA值的差异具有统计学意义（P0.1）。3.多因素分析显示术后Gleason评分、淋巴结转移及切缘情况是术后PSA异常的独立影响因素。术后Gleason评分每上升一个等级术后PSA异常风险增加2.2倍（OR值为2.202，95%可信区间1.026～4.725），淋巴结转移阳性术后PSA异常风险是淋巴结转移阴性的35.3倍（OR值为35.332，，95%置信区间为3.45～361.8），手术切缘阳性术后PSA异常风险是切缘阴性的7.4倍(OR值为7.401，95%可信区间为1.467～37.333）。 结论:1.单因素分析显示：术前tPSA、新辅助治疗、术后Gleason评分、病理分期、淋巴结及切缘情况是根治术后PSA异常的影响因素。2.多因素分析显示:术后Gleason评分、淋巴结转移、切缘情况是根治术后PSA异常的独立影响因素，Gleason评分≥8分、淋巴结转移阳性及手术切缘阳性的患者术后PSA异常的发生率显著升高。3.前列腺癌根治术后PSA0.2ng/ml时，除考虑肿瘤残留或转移因素外，高Gleason评分也是PSA异常的原因；因此对于切缘阴性和淋巴结阴性而高Gleason评分的患者选择密切随访，也可行内分泌治疗。
[Abstract]:Objective: to analyze the clinical related factors of abnormal PSA after radical prostatectomy in order to provide evidence for individualized treatment of prostate cancer. Methods: retrospective analysis was used. The clinical data of 72 patients with prostate cancer undergoing radical prostatectomy in the first affiliated Hospital and affiliated Cancer Hospital of Guangxi Medical University from January 2004 to October 2013 were analyzed. Age, serum total prostate specific antigen (TPSA) level, prostate volume, rectal digital examination, imaging findings, neoadjuvant therapy and puncture Gleason score were observed. The influence of postoperative Gleason score, clinical stage, pathological stage, lymph node metastasis and surgical margin on postoperative PSA. Statistical method: t test was used to compare the mean of samples. Percentage comparison was carried out by chi-square test and multivariate analysis by binary Logistic regression. Results 1. Univariate analysis showed age, prostate volume, rectal digital examination, and imaging findings. There was no significant difference in Gleason score and clinical staging between the two groups (P < 0. 1). 2. Neoadjuvant therapy, preoperative tpsa, pathological staging. Postoperative Gleason score, lymph node metastasis and margin were significantly different in postoperative PSA. Multivariate analysis showed postoperative Gleason score. Lymph node metastasis and margin were independent factors of postoperative PSA abnormality. The risk of abnormal PSA was increased by 2.2-fold with each increase of postoperative Gleason score (OR = 2.202). 95% confidence interval 1.026 ~ 4.725%. The risk of PSA abnormality after lymph node metastasis was 35.3 times higher than that of negative lymph node metastasis. The OR value was 35.332. The confidence interval of 95% was 3.45 / 361.8, and the odds ratio of PSA abnormality after operation with positive margin was 7.401.The odds ratio of negative margin was 7.401. The confidence interval (CI) of 95% was 1.467m 37.333g. Conclusion 1. Univariate analysis showed: preoperative tpsa, neoadjuvant therapy, postoperative Gleason score, pathological staging. Lymph node and incisal margin were the influential factors of PSA abnormality after radical operation. 2. Multivariate analysis showed that: postoperative Gleason score, lymph node metastasis. The margin condition was the independent factor of PSA abnormality after radical operation and the Gleason score was 鈮

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