一个以前列腺特异抗原密度和穿刺评分为基础的中国人群中前列腺癌根治术后病理升级预测模型的建立
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摘要
目的:分析前列腺癌根治术后病理得分较穿刺得分增加的原因,并建立一个可以预测中国人群中前列腺癌根治术后病理升级的模型。方法:以2008年8月至2013年12月在我院泌尿科行前列腺癌根治性切除术的264例患者的临床资料为基础,根据术前和术后患者病理得分的变化将其分为升级组和未升级组。运用单因素和多因素logistic回归分析病理升级的原因,并通过多因素回归系数建立预测病理升级的诺模图。结果:264例患者中,共238例最终纳入统计分析,多因素logistic回归分析显示前列腺特异抗原密度(0R=3.854,P=0.001)和穿刺Gleason(≤6)评分是中国人群中前列腺癌根治术后病理升级的独立危险因素。前列腺特异抗原密度和穿刺得分的ROC最佳截断取值为0.37 ng/ml 2和8分。运用上述两个变量建立了一个可用于预测病理升级的诺模图。结论:前列腺特异抗原密度和穿刺Gleason评分是预测中国人群中前列腺癌根治术后病理升级的独立危险因素,本研究所得的诺模图可以很好地预测前列腺癌根治术后的病理升级。
Objective: To analyze the reason of upgrade in Gleason score between initial prostate biopsy and final radical prostatectomy specimens and develop a nomogram to predict the probability of pathological upgrade. Methods: From August 2008 to December 2013, a total of 264 prostate cancer patients underwent RP in our department were selected and divided into two groups according to the upgrade of biopsy and final pathology GS. Both a univariate analysis and a Forward conditional multivariate logistic regression model(LRM) analysis were performed to identify the risk factor(s) of pathological upgrade. A nomogram predicting the probability of pathological upgrade was established by using LRM regression coefficients. Results: In total, 238 of the 264 patients were analyzed. Multivariate logistic regression analysis showed that higher prostate specific antigen density(PSAD)(0R=3.854, P=0.001) and low grade(≤6) biopsy GS were. The dependent risk factors of the pathological upgrade after radical prostatectomy. The optimal cutoff value of PASD and biopsy score were 0.37 ng/ml 2 and 8 points. A nomogram combining aforementioned two variables to predict pathological upgrading was established. Conclusion: PASD and biopsy Gleason score were independent risk factors for predicting the postoperative pathological upgrade in Chinese population, the nomogram established in the study could well predict the pathological upgrade.
Objective: To analyze the reason of upgrade in Gleason score between initial prostate biopsy and final radical prostatectomy specimens and develop a nomogram to predict the probability of pathological upgrade. Methods: From August 2008 to December 2013, a total of 264 prostate cancer patients underwent RP in our department were selected and divided into two groups according to the upgrade of biopsy and final pathology GS. Both a univariate analysis and a Forward conditional multivariate logistic regression model(LRM) analysis were performed to identify the risk factor(s) of pathological upgrade. A nomogram predicting the probability of pathological upgrade was established by using LRM regression coefficients. Results: In total, 238 of the 264 patients were analyzed. Multivariate logistic regression analysis showed that higher prostate specific antigen density(PSAD)(0R=3.854, P=0.001) and low grade(≤6) biopsy GS were. The dependent risk factors of the pathological upgrade after radical prostatectomy. The optimal cutoff value of PASD and biopsy score were 0.37 ng/ml 2 and 8 points. A nomogram combining aforementioned two variables to predict pathological upgrading was established. Conclusion: PASD and biopsy Gleason score were independent risk factors for predicting the postoperative pathological upgrade in Chinese population, the nomogram established in the study could well predict the pathological upgrade.
引文
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[2]Lughezzani G,Briganti A,Karakiewicz PI,et al.Predictive and prognostic models in radical prostatectomy(RP)candidates:a critical analysis of the literature[J].Eur Urol,2010,58(5):687-700
[3]Barocas DA,Cowan JE,Smith JA Jr,et al.What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance?An analysis of the Ca PSURE database[J].J Urol,2008,180(4):1330-1334
[4]Dall’Era MA,Albertsen PC,Bangma C,et al.Active surveillance for prostate cancer:a systematic review of the literature[J].Eur Urol,2012,62(6):976-983
[5]Vellekoop A,Loeb S,Folkvaljon Y,et al.Population Based Study of Predictors of Adverse Pathology among Candidates for Active Surveillance with Gleason 6 Prostate Cancer[J].The Jour nal of urology,2014,191(2):350-357
[6]Lima NG,Soares Dde F,Rhoden EL.Importance of prostate-specific antigen(PSA)as apredictive factor for concordance between the Gleason scores of prostate biopsies and Radical prostatectomy specimens[J].Clinical science,2013,68(6):820-824
[7]Busch J,Magheli A,Leva N,et al.Higher rates of upgrading and upstaging in older patients undergoing radical prostatectomy and qualifying for active surveillance[J].BJU International,2013,Sep.20
[8]Sfoungaristos S,Katafigiotis I,Perimenis P.The role of PSA density to predict a pathological tumour upgrade between needle biopsy and radical prostatectomy for low risk clinical prostate cancer in the modified Gleason system era[J].Can Urol Assoc j,2013,7(11-12):e722-727
[9]Sfoungaristos S,Perimenis P.Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer[J].Can Urol Assoc j,2012,7(1-2):E93-E97
[10]Chung MS,Lee SH,Lee DH.Is Small Prostate Volume a Predictor of Gleason Score Upgrading after Radical Prostatectomy?[J].Yonsei Med J,2013,54(4):902-906
[11]Hamada S,Horiguchi A,Kuroda K,et al.Elevated Fatty Acid Synthase Expression in Prostate Needle Biopsy Cores Predicts Upgraded Gleason Score in Radical Prostatectomy Specimens[J].The Prostate,2014,74(1):90-96
[12]Epstein JI,Feng Z,Trock BJ,et al.Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy:inci dence and predictive factors using the modified Gleason grading system and factoring in tertiary grades[J].Eur Urol,2012,61(5):10-19
[13]Krane LS,Menon M,Kaul SA,et al.Role of PSA velocity in predicting pathologic upgrade for Gleason 6 prostate cancer[J].Urol Oncol,2011,29(4):372-377
[14]Chun F K-H,Steuber T,Erbersdobler A,et al.Development and Internal Validation of a Nomogram Predicting the Probability of Prostate Cancer Gleason Sum Upgrading Between Biopsy and Radical Prostatectomy Pathology[J].European urology,2006,49:820-822
[15]Moussa AS,Kattan MW,Berglund R,et al.A nomogram for predicting upgrading in patients with low-and intermediate-grade prostate cancer in the era of extended prostate sampling[J].BJU International,2009,105:352-358
[16]Budus L,Graefen M,Salomon G,et al.The novel nomogram of Gleason sum upgrade:Possible application for the eligible criteria of low dose rate brachytherapy[J].International Journal of Urology,2012,17:862-868
[17]Capitanio U,Karakiewicz PI,Valiquette L,et al.Biopsy core number represents 1 of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer[J].Urology,2009,73:1087-1091
[18]Cohen MS,Hanley RS,Kurteva T,et al.Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System:The Lahey Clinic Medical Center Experience and an International Meta-Analysis[J].European urology,2008,54(2):371-381
[19]Sved PD,Gomez P,Manoharan M,et al.Limitations of biopsy Gleason grade:implications for counseling patients with biopsy Gleason score 6 prostate cancer[J].J Urol,2004,172(1):98-102
[20]Corcoran NM,Casey RG,Hong M KH,et al.The ability of prostate-specific antigen density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade due to reduced PSA secretion per unit tumour volume[J].Bju international,2011,110(1):36-42
[21]San Francisco IF,De Wolf WC,Rosen S,et al.Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy[J].J Urol1,2003,69(1):136-140
[22]Freedland SJ,Kane CJ,Amling CL,et al.Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer[J].J Urol,2006,175(4):1298-1302
[23]King CR.Patterns of prostate cancer biopsy grading:trends and clinical implications[J].Int J Cancer,2000,90(6):305-311
[24]Muntener M,Epstein JI,Hernandez DJ,et al.Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy[J].Eur Urol,2008,53(4):767-775
[25]Rune K,Bjφrn Mφller,Rolf W,et al.Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens:a population-based study[J].BJU International,2008,103(12):1647-1654
[26]Allsbrook WC Jr,Mangold KA,Johnson MH,et al.Interobserver reproducibility of Gleason grading of prostatic carcinoma:general pathologist[J].Hum Pathol,2001,32(1):81-88
[2]Lughezzani G,Briganti A,Karakiewicz PI,et al.Predictive and prognostic models in radical prostatectomy(RP)candidates:a critical analysis of the literature[J].Eur Urol,2010,58(5):687-700
[3]Barocas DA,Cowan JE,Smith JA Jr,et al.What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance?An analysis of the Ca PSURE database[J].J Urol,2008,180(4):1330-1334
[4]Dall’Era MA,Albertsen PC,Bangma C,et al.Active surveillance for prostate cancer:a systematic review of the literature[J].Eur Urol,2012,62(6):976-983
[5]Vellekoop A,Loeb S,Folkvaljon Y,et al.Population Based Study of Predictors of Adverse Pathology among Candidates for Active Surveillance with Gleason 6 Prostate Cancer[J].The Jour nal of urology,2014,191(2):350-357
[6]Lima NG,Soares Dde F,Rhoden EL.Importance of prostate-specific antigen(PSA)as apredictive factor for concordance between the Gleason scores of prostate biopsies and Radical prostatectomy specimens[J].Clinical science,2013,68(6):820-824
[7]Busch J,Magheli A,Leva N,et al.Higher rates of upgrading and upstaging in older patients undergoing radical prostatectomy and qualifying for active surveillance[J].BJU International,2013,Sep.20
[8]Sfoungaristos S,Katafigiotis I,Perimenis P.The role of PSA density to predict a pathological tumour upgrade between needle biopsy and radical prostatectomy for low risk clinical prostate cancer in the modified Gleason system era[J].Can Urol Assoc j,2013,7(11-12):e722-727
[9]Sfoungaristos S,Perimenis P.Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer[J].Can Urol Assoc j,2012,7(1-2):E93-E97
[10]Chung MS,Lee SH,Lee DH.Is Small Prostate Volume a Predictor of Gleason Score Upgrading after Radical Prostatectomy?[J].Yonsei Med J,2013,54(4):902-906
[11]Hamada S,Horiguchi A,Kuroda K,et al.Elevated Fatty Acid Synthase Expression in Prostate Needle Biopsy Cores Predicts Upgraded Gleason Score in Radical Prostatectomy Specimens[J].The Prostate,2014,74(1):90-96
[12]Epstein JI,Feng Z,Trock BJ,et al.Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy:inci dence and predictive factors using the modified Gleason grading system and factoring in tertiary grades[J].Eur Urol,2012,61(5):10-19
[13]Krane LS,Menon M,Kaul SA,et al.Role of PSA velocity in predicting pathologic upgrade for Gleason 6 prostate cancer[J].Urol Oncol,2011,29(4):372-377
[14]Chun F K-H,Steuber T,Erbersdobler A,et al.Development and Internal Validation of a Nomogram Predicting the Probability of Prostate Cancer Gleason Sum Upgrading Between Biopsy and Radical Prostatectomy Pathology[J].European urology,2006,49:820-822
[15]Moussa AS,Kattan MW,Berglund R,et al.A nomogram for predicting upgrading in patients with low-and intermediate-grade prostate cancer in the era of extended prostate sampling[J].BJU International,2009,105:352-358
[16]Budus L,Graefen M,Salomon G,et al.The novel nomogram of Gleason sum upgrade:Possible application for the eligible criteria of low dose rate brachytherapy[J].International Journal of Urology,2012,17:862-868
[17]Capitanio U,Karakiewicz PI,Valiquette L,et al.Biopsy core number represents 1 of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer[J].Urology,2009,73:1087-1091
[18]Cohen MS,Hanley RS,Kurteva T,et al.Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System:The Lahey Clinic Medical Center Experience and an International Meta-Analysis[J].European urology,2008,54(2):371-381
[19]Sved PD,Gomez P,Manoharan M,et al.Limitations of biopsy Gleason grade:implications for counseling patients with biopsy Gleason score 6 prostate cancer[J].J Urol,2004,172(1):98-102
[20]Corcoran NM,Casey RG,Hong M KH,et al.The ability of prostate-specific antigen density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade due to reduced PSA secretion per unit tumour volume[J].Bju international,2011,110(1):36-42
[21]San Francisco IF,De Wolf WC,Rosen S,et al.Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy[J].J Urol1,2003,69(1):136-140
[22]Freedland SJ,Kane CJ,Amling CL,et al.Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer[J].J Urol,2006,175(4):1298-1302
[23]King CR.Patterns of prostate cancer biopsy grading:trends and clinical implications[J].Int J Cancer,2000,90(6):305-311
[24]Muntener M,Epstein JI,Hernandez DJ,et al.Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy[J].Eur Urol,2008,53(4):767-775
[25]Rune K,Bjφrn Mφller,Rolf W,et al.Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens:a population-based study[J].BJU International,2008,103(12):1647-1654
[26]Allsbrook WC Jr,Mangold KA,Johnson MH,et al.Interobserver reproducibility of Gleason grading of prostatic carcinoma:general pathologist[J].Hum Pathol,2001,32(1):81-88