Construction and analysis of preoperative model of lymph node metastasis in patients with prostate cancer
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摘要: 目的:通过建立前列腺癌患者淋巴结转移术前模型,指导临床制定扩大盆腔淋巴结清扫范围的临床决策。方法:回顾性收集2017年1月—2020年1月136例前列腺癌患者的临床资料,发现31例患者出现转移,将其作为转移组,将其余105例未出现转移的患者作为对照组,比较两组患者临床资料、实验室检查资料及影像学资料等,并采用多因素Logistic回归分析影响前列腺癌患者淋巴结转移的危险因素;使用逻辑回归构建模型,分析该模型在术前预测前列腺癌患者淋巴结转移的诊断效能,另随机收集同期接受根治术治疗的50例前列腺癌患者的临床资料,采用最临近匹配法,匹配比例1∶1,卡钳值设为0.02,以50例前列腺癌患者的临床资料为基准进行匹配,最终纳入50例未转移患者的临床资料,作为验证集验证预测效能。结果:转移组血清总前列腺特异性抗原(tPSA)[(50.46±10.72)ng/mL vs.(46.34±6.87)ng/mL]、游离PSA百分比[(0.57±0.12) vs.(0.51±0.13)]、前列腺体积[(65.84±20.58)mL vs.(57.85±16.70)mL]、格里森得分[(5.54±1.07)vs.(5.00±1.08)]均高于对照组(P<0.05),Logistic多因素分析筛选出tPSA(OR=1.066)、前列腺体积(OR=1.059)及格里森得分(OR=1.682)为前列腺癌患者淋巴结转移的独立危险因素;使用逻辑回归对tPSA、前列腺体积及格里森得分指标构建预测模型,分析显示列线图模型预测发生淋巴结转移的C-index为0.913,且校正曲线显示列线图模型预测可能性绝对误差为0.018。结论:构建逻辑回归预测模型能够用于早期评估前列腺癌患者淋巴结转移风险,能为前列腺癌根治术扩大盆腔淋巴结清扫范围提供一定参考。Abstract: Objective: To establish a preoperative model of lymph node metastasis in patients with prostate cancer to guide the clinical decision to expand the scope of pelvic lymph node dissection.Methods: The clinical data of 136 patients with prostate cancer from January 2017 to January 2020 were retrospectively collected. Thirty-one patients with metastases were studied as the metastasis group, and 105 patients without metastasis were studied as the control group. The clinical data, laboratory examination data and imaging data of the two groups of patients were used to analyze the risk factors of lymph node metastasis in prostate cancer patients by multivariate logistic regression. Logistic regression was used to construct a model, and the model to predict the lymph nodes in prostate cancer patients before surgery for the diagnostic efficiency of metastasis was analyzed. The clinical data of 50 prostate cancer patients who underwent radical resection during the same period were randomly collected. The nearest matching method was adopted. The matching ratio was 1:1, and the caliper value was set to 0.02. The clinical data of 50 prostate cancer patients as a benchmark for matching, the clinical data of 50 non-metastatic patients were finally included as a validation set to verify the predictive performance.Results: The total prostate specific antigen [(50.46±10.72)ng/mL vs.(46.34±6.87)ng/mL], percentage of free PSA [(0.57±0.12)vs.(0.51±0.13)], prostate volume [(65.84±20.58)mL vs.(57.85±16.70)mL], Gleason scores [(5.54±1.07)vs.(5.00±1.08)] of the metastasis group were higher than those of the control group(P<0.05). Logistic multivariate analysis screened tPSA(OR=1.066), prostate volume(OR=1.059) and Gleason score(OR=1.682) as independent risk factors for lymph node metastasis in prostate cancer patients. Logistic regression was used to construct a predictive model for tPSA, prostate volume and Gleason score. Analysis showed that the C-index of the nomogram model to predict lymph node metastasis was 0.913, and the calibration curve showed that the absolute error of the nomogram model's prediction probability was 0.018.Conclusion: Based on a variety of clinical information from patients, the construction of a logistic regression prediction model can be used for early assessment of the risk of lymph node metastasis in patients with prostate cancer, and can provide reference for expanding the scope of pelvic lymph node dissection during radical prostatectomy.
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[1] Hatano K,Tanaka J,Nakai Y,et al.Utility of index lesion volume assessed by multiparametric MRI combined with Gleason grade for assessment of lymph node involvement in patients with high-risk prostate cancer[J].Jpn J Clin Oncol,2020,50(3):333-337.
[2] 张鸿毅,赵刚刚,李华锋,等.Gleason评分8分的转移性前列腺癌患者预后分析[J].山东医药,2019,59(8):44-47.
[3] Preisser F,Mazzone E,Nazzani S,et al.North American population-based validation of the National Comprehensive Cancer Network Practice Guideline Recommendations for locoregional lymph node and bone imaging in prostate cancer patients[J].Br J Cancer,2018,119(12):1552-1556.
[4] Grivas N,Wit E,Tillier C,et al.Validation and head-to-head comparison of three nomograms predicting probability of lymph node invasion of prostate cancer in patients undergoing extended and/or sentinel lymph node dissection[J].Eur J Nucl Med Mol Imaging,2017,44(13):2213-2226.
[5] Maxeiner A,Grevendieck A,Pross T,et al.Lymphatic micrometastases predict biochemical recurrence in patients undergoing radical prostatectomy and pelvic lymph node dissection for prostate cancer[J].Aktuelle Urol,2019,50(6):612-618.
[6] Cao HM,Wan Z,Wu Y,et al.Development and internal validation of a novel model and markers to identify the candidates for lymph node metastasis in patients with prostate cancer[J].Medicine(Baltimore),2019,98(30):e16534.
[7] 张鸿毅,赵刚刚,李华锋,等.改良Gleason评分系统在7分转移性前列腺癌预后评估中的意义及与VEGF-C表达的关系[J].东南大学学报(医学版),2019,38(3):451-455.
[8] Hueting TA,Cornel EB,Somford DM,et al.External Validation of Models Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients[J].Eur Urol Oncol,2018,1(5):411-417.
[9] 崔少泽,王杜娟,王苏桐,等.基于GMM-RBF神经网络的前列腺癌诊断方法[J].管理科学,2018,31(1):33-47.
[10] Mazzone E,Preisser F,Nazzani S,et al.The Effect of Lymph Node Dissection in Metastatic Prostate Cancer Patients Treated with Radical Prostatectomy:A Contemporary Analysis of Survival and Early Postoperative Outcomes[J].Eur Urol Oncol,2019,2(5):541-548.
[11] 黄凤鸣,李晓红,梁勇.伴骨转移前列腺癌患者内分泌治疗后出现早期CRPC的危险因素分析[J].中华男科学杂志,2018,24(8):690-694.
[12] Luchini C,Fleischmann A,Boormans JL,et al.Extranodal extension of lymph node metastasis influences recurrence in prostate cancer:a systematic review and meta-analysis[J].Sci Rep,2017,7(1):2374.
[13] Lakes J,Arsov C.PSA screening and molecular markers[J].Urologe A,2019,58(5):486-493.
[14] Akbayır S,Muşlu N,Erden S,et al.Diagnostic value of microRNAs in prostate cancer patients with prostate specific antigen(PSA)levels between 2,and 10 ng/mL[J].Turk J Urol,2016,42(4):247-255.
[15] Chen J,Cao S,Situ B,et al.Metabolic reprogramming-based characterization of circulating tumor cells in prostate cancer[J].J Exp Clin Cancer Res,2018,37(1):127.
[16] Turk H,Ün S,Koca O,et al.The factors that affect the prediction of lymph node metastasis in prostate cancer[J].J Cancer Res Ther,2018,14(5):1094-1098.
[17] Zhu YC,Shan J,Zhang Y,et al.Strain Elastography-Targeted Biopsy:Does Prostate Volume Affect Prostate Cancer Detection?[J].Med Sci Monit,2019,25:8836-8842.
[18] 杨倩,朱长清,叶晨安.横纹肌溶解症致急性肾损伤危险因素的Logistic回归分析[J].临床急诊杂志,2020,21(3):236-239,243.
[19] Nordström T,Akre O,Aly M,et al.Prostate-specific antigen(PSA)density in the diagnostic algorithm of prostate cancer[J].Prostate Cancer Prostatic Dis,2018,21(1):57-63.
[20] Mu HQ,He YH,Wang SB,et al.MiR-130b/TNF-α/NF-κB/VEGFA loop inhibits prostate cancer angiogenesis[J].Clin Transl Oncol,2020,22(1):111-121.
[21] Puca L,Vlachostergios PJ,Beltran H.Neuroendocrine Differentiation in Prostate Cancer:Emerging Biology,Models,and Therapies[J].Cold Spring Harb Perspect Med,2019,9(2):a030593.
[22] Preisser F,Bandini M,Marchioni M,et al.Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion[J].Prostate,2018,78(6):469-475.
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