前列腺癌临床分期方法与术后病理分期一致性比较

目的　探讨前列腺癌临床分期方法预测病理分期对选择治疗、判断疗效和评估预后的意义。　方法　对 34例局限性前列腺癌患者术前根据血清前列腺特异性抗原 (PSA)、穿刺后Gleason评分、阳性穿刺针数百分率、直肠指诊和MRI检查进行临床分期 ,与前列腺癌根治术后病理分期进行比较 ,评价其诊断性实验结果。　结果　 34例术后病理诊断B期 2 0例 (5 8 8% ) ,C期 12例(35 3% ) ,D期 2例 (5 9% )。其中血清PSA、Gleason评分、阳性穿刺百分率、直肠指诊和MRI分期对术后病理分期的诊断一致性有显著相关性 (P <0 0 1)。每种临床分期对病理分期的诊断一致性偏低或偏高 ,其敏感性高于 90 0 % ,其中MRI的特异性为 71 4 % ,对前列腺内肿瘤 (B期 )的预测为80 9% ;血清PSA、阳性穿刺百分率和MRI对浸润前列腺包膜及包膜外肿瘤 (C期 )的预测为 90 9%。阳性穿刺百分率的准确性为 82 4 %。　结论　血清PSA、Gleason评分、穿刺阳性针数百分率、直肠指诊和MRI可初步预测前列腺癌的病理分期 ,综合多种临床分期方法能较准确预测前列腺癌的病理分期 ,选择合理的治疗方法。

Comparison of identity between the clinical staging and the pathological staging for prostate cancer in radical prostatectomy

Objective To explore the significance of clinical staging methods for prostate cancer before radical prostatectomy in the prediction of pathological stage, the selection of therapy, judgement of efficacy and the evaluation of prognosis. Methods Thirty-four patients with organ confined prostatic cancer were reviewed to compare the serum prostate specific antigen(PSA), Gleason score staging by biopsies, percentage of positive prostate biopsies staging, digital rectal examination(DRE) staging and magnetic resonance imaging(MRI) staging with the pathological staging results after radical prostatectomy. Results Pathological diagnosis by radical prostatectomy showed that 20 of 34(58.8%) patients with prostate cancer were in stage B, and 12 (35.3%) in stage C and 2 (5.9%) in stage D. All methods for cancer staging were significantly correlated with the pathological staging results ( P <0.01). The sensitivity of each method was as high as 90.0%. The specificity of MRI was 71.4%, and its positive predictive value for organ-confined disease was 80.9%. The negative predictive value of the serum PSA, the percentage of positive prostate biopsies and MRI for nonorgan-confined cancer was 90.9%. The accuracy of the percentage of positive prostate biopsies was 82.4%. Conclusions The serum PSA staging, Gleason score staging, the percentage of positive prostate biopsies staging, DRE staging and MRI can predict the pathological staging results. The combination of above methods for staging increases the prediction of pathological staging results before radical prostatectomy and is helpful in determining the appropriate therapy.