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学科主题: 外科学
题名:
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
作者: 任达
答辩日期: 2016-05-19
导师: 周利群
专业: 外科学
授予单位: 北京大学
授予地点: 北京大学第一临床医学院
学位: 博士
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
分类号: R737.25
摘要:

摘要(一)PSA4-10ng/ml前列腺癌的预测模型的建立和评估

目的:

分析常用检查方法对PSA4-10ng/ml前列腺癌的诊断价值,建立合适的预测模型,提高对PSA4-10ng/ml前列腺癌及高危前列腺癌的检出率。

材料和方法:

收集2011年1月至2015年1月在北京大学第一医院泌尿外科因PSA升高在4-10ng/ml范围内就诊的512例患者的临床资料。收集的临床资料包括患者一般临床特征,直肠指诊,PSA及其衍生指标结果,MRI及前列腺穿刺病理结果。不同组之间的计量数据比较采用曼-惠特尼U检验,计数数据采用卡方检验,通过ROC曲线和曲线下面积比较计量数据对PSA4-10ng/ml前列腺癌的诊断价值。采用多因素logistic回归分析及回归系数寻找可能的预测因素,建立对PSA4-10ng/ml前列腺癌的预测模型,并评估预测模型对PSA4-10ng/ml的前列腺癌诊断价值。

结果:

本研究512名患者的平均年龄为66.6±8.4岁,平均tPSA值为7.14±1.64ng/ml,%fPSA比值为0.19±0.47,平均前列腺体积为57±32ml,平均前列腺密度为0.15±0.09ng/ml2。其中227名患者穿刺病理结果证实为前列腺癌,37例为高危前列腺癌。445名患者(86.9%)DRE结果为阴性,67名患者(13.1%)DRE结果为阳性。MRI结果为阴性的患者117例(22.8%),怀疑可能存在前列腺癌患者201例(39.2%),结果为阳性的患者194例(37.8%)。

tPSA、fPSA、%fPSA、PSAD、年龄和前列腺体积对诊断PSA4-10ng/ml前列腺癌的曲线下面积分别为0.514、0.591、0.616、0.684、0.677和0.721。多因素分析结果显示年龄大于69岁,前列腺体积小于46ml,直肠指诊和MRI结果阳性或可疑阳性是穿刺结果为前列腺癌的独立危险因素。建立包含年龄、前列腺体积、直肠指诊和MRI结果在内的预测模型,其曲线下面积为0.780。

tPSA、fPSA、%fPSA、PSAD、年龄和前列腺体积对诊断高危PSA4-10ng/ml前列腺癌的曲线下面积分别为0.504、0.588、0.610、0.709、0.664和0.727。多因素分析结果显示年龄大于69岁,前列腺体积小于39ml,直肠指诊和MRI结果阳性或可疑阳性是穿刺病理为高危前列腺癌的独立危险因素。建立包含年龄、前列腺体积、直肠指诊和MRI结果在内的预测模型,其曲线下面积为0.808。

结论:

单一的诊断指标对PSA4-10ng/ml的前列腺癌和高危前列腺癌诊断价值不理想。患者的年龄、前列腺体积、MRI结果和直肠指诊结果异常是PSA4-10ng/ml的中国人群穿刺结果为前列腺癌和高危前列腺癌的独立危险因素。建立包括年龄、前列腺体积、MRI结果和直肠指诊结果在内的预测模型能够提高对前列腺癌的诊断效能,帮助临床医师更准确地进行决策分析。

 

摘要(二) PSA4-10ng/ml前列腺癌患者的预后分析

目的:

总结PSA4-10ng/ml前列腺癌患者的总体生存率和肿瘤特异性生存率情况,并寻找其影响因素;分析根治性前列腺切除术后病人的无生化复发率及其危险因素;总结根治性前列腺切除术后病人的控尿功能恢复情况。

材料和方法:

统计2011年1月至2015年1月PSA筛查在4-10ng/ml范围内,并在北京大学第一医院接受B超引导下前列腺穿刺,病理结果诊断为前列腺癌的153例患者的临床资料并进行随访。对接受前列腺根治性切除手术的病人还收集围术期的资料,包括术中是否保留神经血管束,是否行盆腔淋巴结清扫,术后病理结果等资料。随访包括患者的生存状况,死亡的具体原因及时间。对根治性前列腺切除术后的病人还随访其生化复发的时间和控尿功能恢复情况。计量数据比较采用曼-惠特尼U检验,计数数据采用卡方检验。采用Kaplan-meier法绘制PSA4-10ng/ml前列腺癌患者的生存曲线,分析影响总体生存率和肿瘤特异生存率的因素,分析前列腺手术病人的无生化复发率及其可能的影响因素,描述前列腺手术病人术后控尿功能恢复情况。

结果:

入组共153例前列腺癌患者,平均年龄69.7±7.1岁,平均BMI24.3±2.8kg/m2,平均PSA水平7.00±1.54ng/ml。截止随访日期,153例患者存活140例(92.5%),死亡患者13例(8.5%),中位随访时间33个月。PSA4-10ng/ml前列腺癌的5年总体生存率和疾病特异性生存率分别为80.6%和96.2%。其中,手术组和非手术组的5年总生存率分别为95.5%和71.9%。手术组和非手术组的5年疾病特异生存率分别为97.7%和79.3%。穿刺病理的Gleason 评分与疾病特异性生存率相关。94例前列腺根治性切除术后患者16例发生生化复发。1、3、5年无生化复发率分别为90.4%、82.6%和74.2%。年龄、精囊受累、术后病理T分期及Gleason评分是生化复发的独立危险因素。94例前列腺根治性切除术后患者13例未恢复控尿功能,术后第3、6、12个月尿控率分别为63.0%、79.3%和84.8%。

结论:

术前穿刺Gleason评分是影响PSA4-10ng/ml前列腺癌患者疾病特异生存率的独立危险因素。年龄、术后病理Gleason评分、术后病理T分期、精囊是否受累是影响PSA4-10ng/ml前列腺癌术后生化复发的独立危险因素。

 

英文摘要:

Abstract (1): The establishment and evaluation of models to predict prostate cancer with PSA 4-10ng/ml.

Purpose:

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.

Results:

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.

Conclusion:

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

 

Purpose:

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.

Results:

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%。

Conclusion:

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%。

 

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/400002259/125264
Appears in Collections:北京大学第一临床医学院_学位论文

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作者单位: 北京大学第一临床医学院

Recommended Citation:
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.
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