建立一种简易评分系统预测前列腺穿刺活检前列腺癌阳性率

发布时间：2019-02-13 09:58

【摘要】：目的:分析经直肠前列腺穿刺活检前列腺癌阳性率的预测因素。方法:总结2006年1月至2014年4月进行经直肠超声引导下前列腺穿刺活检患者的资料,包括年龄(age)、体质指数(BMI)、症状(syptoms)、直肠指检(DRE)、血清总PSA(t PSA)、游离PSA(f PSA)、游离PSA与总PSA比值(f/t PSA)、前列腺体积(PV)、PSA密度(PSAD)。通过单因素方差分析和多因素回归模型,筛选与活检阳性率相关的危险因素。在此基础上构建一个评分系统作为在活检前预测前列腺癌阳性率的工具,并通过受试者工作特征(ROC)曲线计算假阳性率,以检测评分系统的敏感性。结果:在385例经直肠超声引导下穿刺活检患者中,共139例患者被诊断为前列腺癌,阳性率36.1%。单因素分析显示,在活检阳性组和阴性组之间,年龄(P0.01)、DRE(P0.01)、t PSA(P0.01)、f PSA(P0.01)、f/t PSA(P0.01)、PV(P0.01)和PSAD(P0.01)在前列腺癌患者中比例均高于活检阴性人群。将单因素回归有意义的因素纳入多因素逐步Logistic分析,结果显示,年龄、t PSA、f/t PSA、PV和PSAD是经直肠反复前列腺活检阳性的独立影响因素,其比值比(ORs)及其相应的95%可信区间(95%CIs)分别为1.07(1.05~1.16)、1.05(1.02~1.15)、0.97(0.86~0.99)、0.98(0.87~0.96)和1.79(1.48~2.06)。根据其OR值,设定年龄71岁(中位数)、t PSA14.1μg/L(中位数)、f/t PSA14.07(中位数)、PV42.8 ml(中位数)、PSAD0.31μg/L/ml(中位数)分别各计1分,总分为5分。将385例患者的资料通过评分系统计算前列腺癌的检出率,发现评分为0、1、2、3、4、5分的患者前列腺癌的检出率分别为7.69%、8.98%、15.19%、39.39%、54.55%和72.15%。ROC曲线提示曲线下面积为0.82(95%CI:0.80~0.84,P0.01)。另外,评分3~5分的患者比0~2分的患者前列腺癌的检出率高50%以上(64%vs 11%,P0.01)。结论:该评分系统可以帮助泌尿科医师确定需要行前列腺活检的患者。
[Abstract]:Objective: to analyze the predictive factors of prostate cancer positive rate by transrectal prostate biopsy. Methods: data of patients undergoing transrectal ultrasound guided prostate biopsy from January 2006 to April 2014 were summarized, including age (age), body mass index (BMI),) symptoms, (syptoms), rectal finger biopsy (DRE), total serum PSA (t PSA),. Free PSA (f PSA), ratio of free PSA to total PSA (f / t PSA), (PV), PSA density (PSAD).) Single factor analysis of variance (ANOVA) and multivariate regression model were used to screen the risk factors associated with positive rate of biopsy. On this basis, a scoring system was constructed as a tool to predict the positive rate of prostate cancer before biopsy, and the false positive rate was calculated by the (ROC) curve of the subjects' operating characteristics to detect the sensitivity of the scoring system. Results: of 385 patients with transrectal ultrasound guided biopsy 139 patients were diagnosed with prostate cancer and the positive rate was 36.1%. Univariate analysis showed that age (P0.01), DRE (P0.01), t PSA (P0.01), f PSA (P0.01), frt PSA (P0.01) between positive and negative biopsy group, The proportion of PV (P0.01) and PSAD (P0.01) in prostate cancer patients was higher than that in biopsy negative patients. Univariate regression significant factors were included in multivariate stepwise Logistic analysis. The results showed that age, t PSA,f/t PSA,PV and PSAD were independent influencing factors of prostate biopsies positive through rectum. The ratio of (ORs) and its corresponding 95% confidence interval (95%CIs) were 1.07 (1.05-1.16), 1.05 (1.02v 1.15), 0.97 (0.860.99), respectively. 0.98 (0.870.96) and 1.79 (1.482.06). According to their OR values, the set age of 71 years (median), t PSA14.1 渭 g / L), f / t PSA14.07 (median), PV42.8 ml (median) and PSAD0.31 渭 g/L/ml (median) were 1, respectively, with a total score of 5. The detection rate of prostate cancer was calculated by a scoring system in 385 patients. It was found that the detection rate of prostate cancer with a score of 0 1 / 2 or 3 / 4 and 5 / 5 was 7.69 / 8.98 / 15.19 and 39.39, respectively. The area under the curve indicated by 54.55% and 72.15%.ROC curve was 0.82. In addition, the detection rate of prostate cancer in patients with 3 ~ 5 scores was more than 50% higher than that with 0 ~ 2 scores (64%vs 11 / P0.01). Conclusion: this scoring system can help urologists identify patients who need prostate biopsies.
【作者单位】：南通市第一人民医院泌尿外科;东南大学附属中大医院泌尿外科;
【分类号】：R737.25

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