前列腺癌分期方法的临床评价

目的 :探讨临床参数对前列腺癌分期的临床意义。　方法 :通过病理诊断、MRI检查及全身骨扫描对 112例经前列腺活检病理证实的前列腺癌进行分期 ,结合血清前列腺特异抗原 (PSA)、穿刺后Gleason评分、穿刺阳性针数百分率评价其临床意义。　结果 :112例前列腺癌中 ,血清PSA、Gleason评分、穿刺阳性针数百分率对前列腺癌分期有显著相关性 (r=0 .6 98,r=0 .6 74 ,r=0 .6 71,P均 <0 .0 0 1) ,但对B期和C期前列腺癌的诊断差异无显著性 (χ2=2 .6 75 ,P =0 .0 96 ;χ2 =0 .70 4 ,P =0 .4 0 1) ,血清PSA较Gleason评分和穿刺阳性针数百分率对D期的诊断差异有显著性 (χ2 =5 .135 ,P =0 .0 2 3;χ2 =4 .5 93,P =0 .0 32 )。血清PSA、Gleason评分和穿刺阳性针数百分率的敏感性分别为 76 .7%、83.3%和 77.8% ,特异性为 5 0 %、77.3%和 5 4 .5 % ,准确性为 71.4 %、82 .1%和 73.2 %。　结论 :血清PSA、Gleason评分、穿刺阳性针数百分率可预测前列腺癌的分期 ,穿刺后Gleason评分对前列腺癌分期的预测较血清PSA和穿刺阳性针数百分率更准确。血清PSA对远处转移性前列腺癌的预测更有意义

Evaluation for Clinical Staging Parameters of Prostate Neoplasm

OBJECTIVES: To evaluate significance of clinical parameters in prostate cancer staging. METHODS: One hundred and twelve patients of prostate cancer were diagnosed by transrectal ultrasound-guided prostate needle biopsies. These cases were staged by pathologic diagnosis, MRI and bone scan. Clinical significance of serum PSA, Gleason score of biopsy, percentage of positive biopsy cores in prostate cancer staging were evaluated. RESULTS: Of 112 patients, 30.4% (34/112) underwent radical retropubic prostatectomy. The serum PSA, Gleason score of biopsy and percentage of positive biopsy cores, were significant correlation with staging prostate cancer (r = 0.698, r = 0.674, r = 0.671, P < 0.001), and no significant difference between staging B and staging C (chi 2 = 2.675, P = 0.096; chi 2 = 0.704, P = 0.401). PSA in patients with stage D had significant difference with others (chi 2 = 5.135, P = 0.023; chi 2 = 4.593, P = 0.032). The sensitivity, specificity and accuracy of PSA were 76.7%, 50.0% and 71.4% respectively. Those of Gleason score and percentage of positive biopsy cores were 83.3%, 77.3%, 82.1% and 77.8%, 54.5%, 73.2% respectively. CONCLUSIONS: The serum PSA, Gleason score of biopsy and percentage of positive biopsy cores had clinical significance in the staging of prostate cancer. Gleason score of biopsy in staging was more accurate than that of the other two parameters and the serum PSA can better predict prostate cancer metastasis.