本文關(guān)鍵詞： 前列腺癌 根治術(shù) PSA異常 影響因素　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：分析前列腺癌根治術(shù)后PSA異常的臨床相關(guān)因素，為前列腺癌患者個(gè)體化后續(xù)治療提供依據(jù)。 方法：采用回顧性分析方法，對2004年1月-2013年10月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院及附屬腫瘤醫(yī)院行前列腺癌根治術(shù)的72例前列腺癌患者的臨床資料進(jìn)行分析，觀察患者的年齡、血清總前列腺特異性抗原水平(tPSA)、前列腺體積、直腸指檢、影像學(xué)表現(xiàn)、新輔助治療、穿刺Gleason評分、術(shù)后Gleason評分、臨床分期、病理分期、淋巴結(jié)轉(zhuǎn)移及手術(shù)切緣情況對術(shù)后PSA值的影響。統(tǒng)計(jì)學(xué)方法：樣本均數(shù)比較采用t檢驗(yàn)，百分?jǐn)?shù)比較采用卡方檢驗(yàn),采用二元Logistic回歸進(jìn)行多因素分析。 結(jié)果:1.單因素分析顯示年齡、前列腺體積、直腸指檢、影像學(xué)表現(xiàn)、穿刺Gleason評分及臨床分期對術(shù)后PSA值的差異無統(tǒng)計(jì)學(xué)意義（P0.1）。2.新輔助治療、術(shù)前tPSA、病理分期、術(shù)后Gleason評分、淋巴結(jié)轉(zhuǎn)移及切緣情況對術(shù)后PSA值的差異具有統(tǒng)計(jì)學(xué)意義（P0.1）。3.多因素分析顯示術(shù)后Gleason評分、淋巴結(jié)轉(zhuǎn)移及切緣情況是術(shù)后PSA異常的獨(dú)立影響因素。術(shù)后Gleason評分每上升一個(gè)等級術(shù)后PSA異常風(fēng)險(xiǎn)增加2.2倍（OR值為2.202，95%可信區(qū)間1.026～4.725），淋巴結(jié)轉(zhuǎn)移陽性術(shù)后PSA異常風(fēng)險(xiǎn)是淋巴結(jié)轉(zhuǎn)移陰性的35.3倍（OR值為35.332，，95%置信區(qū)間為3.45～361.8），手術(shù)切緣陽性術(shù)后PSA異常風(fēng)險(xiǎn)是切緣陰性的7.4倍(OR值為7.401，95%可信區(qū)間為1.467～37.333）。 結(jié)論:1.單因素分析顯示：術(shù)前tPSA、新輔助治療、術(shù)后Gleason評分、病理分期、淋巴結(jié)及切緣情況是根治術(shù)后PSA異常的影響因素。2.多因素分析顯示:術(shù)后Gleason評分、淋巴結(jié)轉(zhuǎn)移、切緣情況是根治術(shù)后PSA異常的獨(dú)立影響因素，Gleason評分≥8分、淋巴結(jié)轉(zhuǎn)移陽性及手術(shù)切緣陽性的患者術(shù)后PSA異常的發(fā)生率顯著升高。3.前列腺癌根治術(shù)后PSA0.2ng/ml時(shí)，除考慮腫瘤殘留或轉(zhuǎn)移因素外，高Gleason評分也是PSA異常的原因；因此對于切緣陰性和淋巴結(jié)陰性而高Gleason評分的患者選擇密切隨訪，也可行內(nèi)分泌治療。
[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

本文編號：1478656