|关键词||前列腺癌 前列腺特异性抗原 诊断 预后 危险因素|
|其他题名||Clinical research on the diagnosis and prognosis of prostate cancer with PSA 4-10 ng/ml|
Abstract (1): The establishment and evaluation of models to predict prostate cancer with PSA 4-10ng/ml.
To evaluate the diagnostic value of the examination commonly used for detection of prostate cancer with PSA 4-10ng/ml, to establish an appropriate prediction model to improve the detection rate of prostate cancer and high risk prostate cancer with PSA 4-10ng/ml.
Materials And Methods:
The data of 512 patients who underwent transrectal ultrasound guided prostate biopsy from 2011 to 2015 was retrospectively analyzed. The range of patients’ prostate specific antigen was from 4 to 10ng/ml. The clinical acteristics, digital rectal examination, prostate specific antigen and its derivative test, magnetic resonance image, pathologic findings of biopsy and prostate volume measured by ultrasound were collected. Man-Whitney U test was used for continuous variables and Chi-square test was used for categorical variables. Multivariate logistic regression was used to calculate the predictive factor. The risk stratification score was generated by the multivariate logistic regression coefficients. Receiver operating acteristic(ROC) curve and area under the curve(AUC) were used to illustrate the accuracy of predictive model.
The median age of the 512 patients was 66.6±8.4 years. The median tPSA was 7.14±1.64ng/ml, and the median %fPSA was 0.19±0.47. The median PV was 57±32ml and the median PSA density was 0.15±0.09ng/ml2. 227 of this cohort were turned out to be prostate cancer and 37 of them were high risk prostate cancer. Negative and positive DRE were present in 445(86.9%) and 67(13.1%) patients each. 194(37.8%) of them showed positive findings and 201(39.2%) showed suspicious positive findings in MRI.
The ROC curve was used to evaluate the diagnostic value of prostate cancer. The AUC of PSA, free PSA, %fPSA, PSA density, age and prostate volume were 0.514, 0.591, 0.616, 0.684, 0.677 and 0.721. In multivariate analysis, age>69, prostate volume<46ml, DRE and MRI positive findings were related to the presence of prostate cancer. The AUC of predictive model of prostate cancer was 0.780 which included the factors of age, prostate volume, DRE and MRI. Similarly the ROC curve was used to evaluate the diagnostic value of high risk prostate cancer. The AUC of PSA, free PSA, %fPSA, PSA density, age and prostate volume were 0.504, 0.588, 0.610, 0.709, 0.664 and 0.727. In multivariate analysis, age>69, prostate volume<39 ml, MRI and DRE positive findings were related to the presence of prostate cancer. The AUC of predictive model of prostate cancer was 0.808 which included the factors of age, prostate volume, DRE and MRI.
Single examination showed poor diagnostic value in both prostate cancer and high risk prostate caner with PSA 4-10ng/ml. Age, prostate volume, positive DRE and MRI findings were related to the presence of prostate cancer and high risk prostate cancer. The predictive model had higher diagnostic value in prostate cancer and high risk prostate cancer with PSA 4-10ng/ml.
Abstract (2) : The prognosis analysis of prostate cancer with PSA 4-10ng/ml
To analyze the survival of prostate cancer with PSA 4-10ng/ml and the prognostic factors on survival. To analyze the risk factors of biochemical recurrence of the patients after radical prostatectomy. To describe the recovery status of urinary continence of the patients after radical prostatectomy.
Materials and Methods:
The data of 153 cases with pathologic confirmed prostate cancer was collected from 2011 to 2015. All the patients reached Peking University First Hospital for treatment with PSA 4-10ng/ml. We collected the patients’ clinical acteristics, living status, cause and time of deaths. 94 patients of the cohort accepted radical prostatectomy. Data of perioperative information and postoperative follow-up was also collected. Man-Whitney U test was used for continuous variables and Chi-square test was used for categorical variables. Overall survival and disease specific survival were analyzed by Kaplan-Meier method. Prognostic factors were analyzed by Log-rank test and Cox proportional hazards model. Postoperative patients’ biochemical recurrence survival curve and risk factors were analyzed by Kaplan-Meier method and Cox proportional hazards model. We also described the recovery condition of urinary continence of the 94 patients after radical prostatectomy. All the statistical tests were performed with SPSS 22.0. All reported p values were two sided with statistical significance considered at p<0.05.
The median age was 69.7±7.1 and the median BMI index was 24.3±2.8kg/m2. The median PSA 7.00±1.54ng/ml. The median time of follow up was 33 months. The 5 year overall and disease specific survival rate was 80.6% and 96.2%. The 5-year overall survival rate of the 94 patients after radical prostatectomy was 95.5%, while others was 71.9%. The 5-year disease specific survival rate of the patients after radical prostatectomy was 97.7%, while others was 79.3%. In the operation group, 16 patients had biochemical recurrence. The 1, 3, 5-year biochemical recurrence free survival rate was 90.4%, 82.6% and 74.2%. Patients’ Age, T stage, Gleason score and seminal vesical invasion were related to biochemical recurrence. Patients’ urinary continence rate at 3, 6, 12 months was 63.0%, 79.3% and 84.8%。
Gleason Score was associated with the disease specific survival. Age, T stage, Gleason score and seminal vesical invasion were found to be risk factors of biochemical recurrence after radical prostatectomy. Postoperative patients’ urinary continence rate at 3, 6, 12 months was 63.0%, 79.3% and 84.8%。
|任达. 前列腺特异性抗原4-10ng/ml的前列腺癌诊断及预后的临床研究[D]. 北京大学第一临床医学院. 北京大学,2016.|