本文關(guān)鍵詞：前列腺癌患者根治術(shù)后病理Gleason評(píng)分升高預(yù)測(cè)因素研究　出處：《第三軍醫(yī)大學(xué)學(xué)報(bào)》2016年24期 　論文類型：期刊論文

  更多相關(guān)文章： 前列腺癌 Gleason評(píng)分 前列腺活檢 前列腺特異性抗原密度

【摘要】：目的探討經(jīng)直腸前列腺穿刺活檢的中低危前列腺癌患者術(shù)后發(fā)生病理Gleason評(píng)分升高的預(yù)測(cè)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檢并行前列腺癌根治手術(shù)的123例中低危前列腺癌患者的臨床資料,回顧性分析術(shù)后發(fā)生Gleason評(píng)分升高與患者年齡、術(shù)前血清總前列腺特異抗原(total prostate specific antigen,t PSA)、術(shù)前血清游離PSA(f PSA)/t PSA、前列腺體積、前列腺特異性抗原密度(PSAD)、穿刺陽(yáng)性針數(shù)比、切緣陽(yáng)性率、穿刺評(píng)分等級(jí)、臨床分期等的關(guān)系,進(jìn)一步分析其預(yù)測(cè)價(jià)值。結(jié)果 123例患者中經(jīng)直腸超聲(transrectal ultrasonography,TRUS)引導(dǎo)下前列腺穿刺活檢病理Gleason評(píng)分與前列腺癌根治術(shù)后病理Gleason評(píng)分保持一致66例(53.7%),評(píng)分下降10例(8.1%),評(píng)分升高47例(38.2%)。前列腺體積、PSAD及穿刺活檢病理Gleason評(píng)分等級(jí)與術(shù)后發(fā)生病理Gleason評(píng)分升高有關(guān)(P0.05)。進(jìn)一步Logistic回歸分析結(jié)果顯示僅PSAD(P=0.01)與穿刺活檢病理Gleason評(píng)分等級(jí)(P=0.03)是前列腺癌根治術(shù)后病理Gleason評(píng)分升高的獨(dú)立預(yù)測(cè)因子。應(yīng)用受試者工作特征(receiver operating characteristic,ROC)曲線分析得出:前列腺穿刺活檢病理Gleason評(píng)分等級(jí)=7的患者,PSAD0.282 ng/(m L·g)時(shí),根治術(shù)后發(fā)生具有臨床意義的Gleason評(píng)分升高的可能性大(敏感性78.2%,特異性70.4%);而前列腺穿刺活檢病理Gleason評(píng)分等級(jí)≤6的患者,PSAD0.265 ng/(m L·g)時(shí),根治術(shù)后發(fā)生具有臨床意義的Gleason評(píng)分升高的可能性大(敏感性77.1%,特異性68.0%)。結(jié)論 PSAD與穿刺評(píng)分等級(jí)是根治術(shù)后病理Gleason評(píng)分升高的獨(dú)立預(yù)測(cè)因子。PSAD與前列腺癌患者術(shù)后發(fā)生病理Gleason評(píng)分升高密切相關(guān)。
[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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