CAJ | 학술논문

目的评价前列腺特异性抗原密度(PSAD)预测临床低中危前列腺癌(PCa)患者首次前列腺活检标本的Gleason评分在根治性前列腺切除术(RP)后评分升高的能力. 方法回顾性分析2008年6月至2012年10月收治的170例低中危PCa患者(PSA≤20 μg/L,分期≤T2b,Gleason评分≤7分)的临床资料,中位年龄68岁,中位PSA为10.2 μg/L,中位PSAD为0.35 mg/L2,中位前列腺体积为28.4 ml.临床分期T1期95例,T2期75例.根据活检Gleason评分分为3组:3+3组91例,3+4组42例,4+3组37例,每组内再根据RP后的Gleason评分是否升高,分为评分一致组和升高组.绘制3组的受试者工作特征(ROC)曲线并计算PSAD的曲线下面积(AUC). 结果本组170例中术后Gleason评分升高79例(46.5％),其中3+3组51例(56.0％),3+4组17例(40.5％),4+3组11例(29.7％).3+3组中升高组的PSAD值(0.37 mg/L2)高于一致组(0.23 mg/L2),差异有统计学意义(P＜0.01).3+4组和4+3组中升高组的PSAD(0.33、0.49 mg/L2)与一致组(0.36、0.58 mg/L2)比较差异均无统计学意义(P＞0.05).3+3、3+4、4+3组ROC曲线的AUC分别为0.762、0.529、0.413.3组中升高组的病理分期均高于一致组,差异均有统计学意义(P＜0.05). 结论在前列腺活检确诊为Gleason评分3+3的临床低中危PCa患者中,PSAD具有预测术后Gleason评分升高的能力.
목적 평개전렬선특이성항원밀도(PSAD)예측림상저중위전렬선암(PCa)환자수차전렬선활검표본적Gleason평분재근치성전렬선절제술(RP)후평분승고적능력. 방법 회고성분석2008년6월지2012년10월수치적170례저중위PCa환자(PSA≤20 μg/L,분기≤T2b,Gleason평분≤7분)적림상자료,중위년령68세,중위PSA위10.2 μg/L,중위PSAD위0.35 mg/L2,중위전렬선체적위28.4 ml.림상분기T1기95례,T2기75례.근거활검Gleason평분분위3조:3+3조91례,3+4조42례,4+3조37례,매조내재근거RP후적Gleason평분시부승고,분위평분일치조화승고조.회제3조적수시자공작특정(ROC)곡선병계산PSAD적곡선하면적(AUC). 결과 본조170례중술후Gleason평분승고79례(46.5％),기중3+3조51례(56.0％),3+4조17례(40.5％),4+3조11례(29.7％).3+3조중승고조적PSAD치(0.37 mg/L2)고우일치조(0.23 mg/L2),차이유통계학의의(P＜0.01).3+4조화4+3조중승고조적PSAD(0.33、0.49 mg/L2)여일치조(0.36、0.58 mg/L2)비교차이균무통계학의의(P＞0.05).3+3、3+4、4+3조ROC곡선적AUC분별위0.762、0.529、0.413.3조중승고조적병리분기균고우일치조,차이균유통계학의의(P＜0.05). 결론 재전렬선활검학진위Gleason평분3+3적림상저중위PCa환자중,PSAD구유예측술후Gleason평분승고적능력.
Objective To investigate the performance of PSAD as a predictor of Gleason score upgrade between initial prostate biopsy and radical prostatectomy(RP)in the patients with low or intermediate risk prostate cancers(PCa).Methods This study comprised a retrospective analysis of data from 170 PCa patients(PSA≤20 μg/L,stage≤T2b,Gleason score≤7).The median age was 68 yrs,the median PSA was 10.2 μg/L,the median PSAD was 0.35 mg/L2 and the median prostate volume was 28.4 ml.There were 95 cases in cT1 and 75 cases in cT2.According to biopsy Gleason score,patients were divided into three groups:3+3(91 cases),3+4(42 cases)and 4+3(37 cases).Each group was further stratified into to subgroups according to whether their RP Gleason score was concordant or upgraded.Receiver-operating characteristic(ROC)curves for predictive power of PSAD were generated for each group,and the area under the curve(AUC)was calculated.Results Of the 170 patients,79(46.5％)had an upgrade in Gleason score,51(56.0％)in 3+3 group,17(40.5％)in 3+4 group,11(29.7％)in 4+3 group,respectively.In the 3+3 group,PSAD was significantly higher in subgroup with upgraded Gleason score compared with the subgroup of concordant Gleason score(0.37 mg/L2 versus 0.23 mg/L2,P＜0.01).In the other two groups,PSAD were not of significant differences between subgroup with upgraded Gleason score and the subgroup of concordant Gleason score(0.33 mg/L2 versus 0.36 mg/L2,0.49 mg/L2 versus 0.58 mg/L2,P＞0.05).ROC analysis showed a decline in AUC with increasing biopsy Gleason score.It was 0.762 for 3+3 group,0.529 for 3+4 group and 0.413 for 4+3 group.The pathologic stage in upgraded cases were more advanced in all the groups(P＜0.05).Conclusion PSAD has the ability of predicting Gleason score upgrade after RP in the biopsy Gleason score 3+3 PCa patients whose clinical risk stratification are low or intermediate.