前列腺特异抗原联合分级对前列腺癌患者分期的预测

目的探讨血清前列腺特异抗原(PSA)联合分级对前列腺癌患者的分期进行预测的方法。方法回顾分析我院泌尿外科187例穿刺活检诊断为前列腺癌患者的临床资料。采用等级相关分析、秩和检验、逐步判别多因素分析方法,分析血清PSA水平、游离PSA百分比(FPSA/TPSA值)与Gleason评分(GS)、分期的关系。结果前列腺癌患者GS越高,血清PSA水平越高(r=0.369,P<0.001)。分期越晚,血清PSA、GS越高(r=0.398,0.530,P均<0.001)。FPSA/TPSA值与分期不相关(P>0.70),但当PSA≤10μg/L时,FPSA/TPSA值与分期呈负相关(r=-0.600,P<0.05)。当PSA>20μg/L时,67%~87%的患者可能为C或D期。用PSA、GS预测分期的公式为x=-3.488+0.041×PSA+0.428×GS。结论血清PSA水平与GS呈正相关。血清PSA水平、GS分别与分期呈正相关。当PSA≤10μg/L时,FPSA/TPSA值与分期呈负相关。运用判别公式x=-3.488+0.041×PSA+0.428×GS可以预测前列腺癌患者的分期。

Prediction of the stage of patients with prostate cancer by the combination of serum prostate specific antigen and Gleason score

OBJECTIVE: To explore the method of predicting the stage of prostate cancer with serum prostate-specific antigen (PSA) and pathological grade. METHODS: One hundred and eighty-seven patients were studied retrospectively with prostate cancer diagnosed by systemic biopsy in our hospital. The rank correlation analysis, rank sum test and stepwise discriminant multivariate analysis were used to assess the correlation of serum PSA level, ratio of free PSA to total PSA (FPSA/TPSA ratio) with Gleason score (GS) and stage. RESULTS: Serum PSA level increased with GS for prostate cancer patients (r = 0.369, P < 0.001). With increasing stage, serum PSA level and GS increased (r = 0.398, 0.530, P < 0.001). Overall, FPSA/TPSA ratio was not correlated with stage (P > 0.70), but a significant negative correlation was demonstrated between them when serum PSA < or = 10 microg/L (r = -0.600, P < 0.05). When serum PSA > 20 microg/L, 67% - 87% patients with prostate cancer may be stage C or D. The equation using serum PSA and GS to predict the stage of patients with prostate cancer was: x = -3.488 + 0.041 x PSA + 0.428 x GS. CONCLUSIONS: Serum PSA level is positively correlated with GS for prostate cancer patients. Serum PSA level and GS are positively correlated with stage. A negative correlation between FPSA/TPSA ratio and stage is demonstrated when serum PSA < or = 10 microg/L. The combination of serum PSA and GS may predict the stage of patients with prostate cancer.