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学科主题: 外科学
题名:
前列腺特异性抗原20μg/L以下前列腺癌患者骨转移的相关因素分析
作者: 侯惠民
答辩日期: 2016-05-17
导师: 刘明
专业: 外科学
授予单位: 北京大学
授予地点: 北京大学第五临床医学院
学位: 硕士
关键词: 前列腺肿瘤 ; 前列腺特异性抗原 ; 骨扫描
其他题名: Various factors of positive rate of bone scan in low PSA patients
分类号: R737.25
摘要:

目的:探讨前列腺特异性抗原(prostate specific antigen,PSA)<20μg/L前列腺癌患者骨转移的相关影响因素。

方法:回顾性分析1997年3月至2013年12月北京医院泌尿外科143例PSA<20μg/L的前列腺癌患者资料,年龄51~88岁,平均71.5岁。患者诊断时PSA为0.05~19.97μg/L,平均9.8μg/L,中位PSA为10.72μg/L。采用Coan-Armitage 趋势检验分析PSA水平、Gleason评分、临床局部病灶分期、穿刺阳性针数百分比与骨转移的相关性。将患者依据PSA分为≤4.0μg/L、4.0~9.9μg/L、10.0~19.9μg/L三组、依据Gleason评分分为≤6、7 、≥8三组、依据临床T 分期分为≤T2或≥T3期两组、依据穿刺阳性针数百分比分为<33%、33%~66%、>66%三组,分别比较不同组间骨转移发生率。将患者根据PSA水平、Gleason评分以及临床肿瘤局部分期分为低危(PSA<10μg/L和Gleason6分或以下和T2a期或以下)、中危1组(PSA10~19.9μg/L或Gleason7分或T2b期,且主要Gleason评分不为4分)、中危2组(PSA10~19.9μg/L或Gleason7分或T2b期,且主要Gleason评分为4分)、高危(PSA≥20μg/L或Gleason8~10分或T2c期或以上)组,比较各组间骨转移发生率。

结果:Gleason评分各组骨转移的阳性结果分别为6(9.5%)例、8例(16.0%)例、7(23.3%)例,差异有统计学意义(P<0.05);临床肿瘤局部分期各组骨转移的阳性结果分别为6(8.3%)、15(31.2%),差异有统计学意义(P<0.05); PSA水平各组阳性结果分别为2例(18.2%)、9例(13.0%)、10例(15.9%),无明显统计学差异(P=0.153);穿刺阳性针数各组阳性结果为6(8.8%)、9(19.1%)、6(21.4%),无明显统计学差异(P=0.862)。低危、中危1组、中危2组、高危组各组骨转移阳性结果分别为0(0%)例、1(4.5%)例、2(11.1)例、17例(21.8%),未见明显统计学差异(P=0.061)。

结论:在PSA<20μg/L前列腺癌患者中,Gleason评分及临床肿瘤局部分期与患者骨转移有相关性,而PSA及穿刺阳性针数百分比与骨转移发生率无明显相关性。本研究中患者在低水平PSA时较同一水平欧美人群骨转移率高,因此沿用欧美初诊前列腺癌患者骨扫描判断标准并不适宜。

英文摘要:

Objective  To analyze the correlation factors on bone metastatic rate in patients with PSA less than 20μg/L.

Methods  A retrospective analysis was made in 143 prostate cancer patients in Beijing Hospital from March 1997 to December 2013 with PSA less than 20μg/L. Their PSA was 0.05~19.97μg/L and mean PSA was 10.72μg/L. According to Gleason score patients were divided into three group with Gleason score £6, 7, ³8. According to T stage patients are divided into £ T2 or ³ T3. According to PSA patients are divided into £4.0μg/L、4.0~9.9μg/L or 10.0~19.9μg/L. According to percentage of positive cores on the bone scan patients are divided into<33%、33%~66% or >66%.The correlation of bone scan with PSA, Gleason score, T stage or percentage of positive cores in biopsy was evaluated.

Result  The bone metastatic rate of each group with Gleason score was 6(9.5%), 8(16.0%) and 7(23.3%), respectively. There was significant difference between them (P<0.05). According to T stage ,the positive rate of each group is 6(8.3%)and 15(31.2%)and there was significant correlation between them (P<0.05). According to PSA .the positive rate of each group is 2 (18.2%)、9(13.0%)or 10(15.9%) and there was no significant correlation between them (P=0.153). According to percentage of positive cores on the bone scan ,the positive rate of each group is 6(8.8%)、9(19.1%) and 6(21.4%)and there was no significant correlation between them (P=0.862).The bone metastatic rate in those with Gleason 6 or less and stage T2 or less is 6.2%.

Conclusion  In patients with PSA less than 20 μg/L, Gleason score and T stage were significant correlated with bone metastatic rate. However, bone metastatic rate had no correlation with PSA and percentage of positive cores in biopsy.For the same low PSA,the Asian people has higher metastases rate than the Europen.So the Europe and the United States criterion for the bone scan of prostate cancer patients is not fit for Chinese.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/124793
Appears in Collections:北京大学第五临床医学院_学位论文

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作者单位: 北京大学第五临床医学院

Recommended Citation:
侯惠民. 前列腺特异性抗原20μg/L以下前列腺癌患者骨转移的相关因素分析[D]. 北京大学第五临床医学院. 北京大学. 2016.
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