总前列腺特异抗原、游离前列腺特异抗原、碱性磷酸酶和Gleason评分联合检测对前列腺癌骨转移的预测价值

探讨总前列腺特异抗原（tPSA）、游离前列腺特异抗原（fPSA）、碱性磷酸酶（ALP）和Gleason评分与前列腺癌骨转移的关系，评价联合检测对前列腺癌骨转移的预测价值。 方法 回顾性分析2015年1月1日至2018年11月1日在本院临床诊断为良性前列腺增生或前列腺癌的患者（tPSA>10 ng/mL）以及健康体检人群的临床资料，其中前列腺癌患者又经核素骨显像分为骨转移组和非骨转移组；共收集304例完整病例进行分析，其中前列腺癌骨转移组48例(15.8%），前列腺癌未发生骨转移组116例（38.2%），良性前列腺增生组56例（18.4%），健康对照组84例（27.6%）。检测分析所有患者的tPSA 、fPSA、ALP值及Gleason评分。结果 任意两组之间的tPSA、fPSA比较,差异均有统计学意义（P<0.05）；前列腺癌骨转移组的ALP均高于其他三组,差异均有统计学意义（P<0.05）；前列腺癌骨转移组的Gleason评分高于非骨转移组,差异有统计学意义（P<0.05），对不同分化程度的前列腺癌患者骨转移率进行比较,发现低风险组的骨转移率明显低于中高风险组（P<0.05）。单指标tPSA、fPSA和ALP预测前列腺癌骨转移时，绘制ROC曲线下面积分别为0.664、0.700和0.783，其cut off值分别为57.47 ng/mL、8.44 ng/mL、85.47 U/L；三项指标联合检测时发现tPSA+fPSA+ALP的特异度和阳性预测值分别达86.20%和64.40%，高于单指标和两项指标联合检测。结论 对于怀疑有骨转移的前列腺癌患者，不宜单独用血清前列腺特异性抗原（PSA）浓度来判断骨转移，应联合tPSA、fPSA、ALP三者及Gleason评分对前列腺癌患者发生骨转移风险的预测。

Predictive value of combined detection of tPSA,fPSA,ALP and Gleason scores for bone metastasis of prostate cancer

To investigate the relationship between tPSA,fPSA,ALP and Gleason scores and bone metastasis of prostate cancer,and to evaluate the predictive value of combined detection for bone metastasis of prostate cancer.Methods  A retrospective analysis of patients with prostatic hyperplasia and prostate cancer(tPSA>10 ng/mL) and healthy subjects in our hospital from January 1,2015 to November 1,2018.Patients with prostate cancer were divided into bone metastasis group and non bone metastasis group by radionuclide bone imaging.A total of 304 complete cases were collected for analysis, including 48 cases(15.8%) of the prostate cancer with bone metastasis group and 116 cases(38.2%) of the prostate cancer with non-bone metastasis group,56 cases(18.4%) of the benign prostatic hyperplasia group and 84 people(27.6%) of the healthy control group.Results  The tPSA and fPSA were significantly different between any two groups(P<0.05).There were significant differences between the bone metastatic group and other three groups of ALP(P<0.05).There was significant difference between the bone metastatic group and non-bone metastasis group of Gleason scores(P<0.05).The bone metastasis rate of prostate cancer patients was lower in low risk group than in middle-risk and high-risk group.When the single index tPSA, fPSA and ALP were used to predict the bone metastasis of prostate cancer,the areas under the ROC curve were 0.664,0.700 and 0.783,respectively.The optimal critical diagnostic values were 57.47 ng/mL,8.44 ng/mL and 85.47 U/L,respectively.It was found that the specificity and positive predictive value of the combined detection of the three indicators(tPSA+fPSA+ALP) were 86.20% and 64.40%,higher than single index and combination of two indicators.Conclusions  For patients with prostate cancer suspected of having bone metastasis,it is not advisable to use serum PSA concentration alone to judge bone metastasis.The risk of bone metastasis should be predicted by combining tPSA,fPSA,ALP and Gleason score.