Analysis of factors affecting the first serum PSA level after radical prostatic cancer resection
-
摘要: 目的 探讨影响前列腺癌根治性切除术后首次血清前列腺特异性抗原(PSA)水平的因素。方法 选择2015年1月—2021年8月在北部战区总医院行根治性切除术的前列腺癌患者251例进行回顾性分析。收集前列腺癌根治性切除术后首次血清PSA水平的可能因素，根据患者术后6~8周时首次PSA检查结果将患者分为PSA < 0.2 ng/mL组和PSA≥0.2 ng/mL组，比较2组患者各项临床指标，并采用二元多因素logistic回归法评估各因素对前列腺癌患者根治性切除术后首次PSA水平的综合作用。结果 251例患者共56例患者血清PSA≥0.2 ng/mL。多因素分析结果显示，BMI增加、T分期为Ⅲ~Ⅳ期、术前PSA水平升高、精囊侵犯及神经侵犯为前列腺癌根治性切除术后首次血清PSA水平升高的危险因素(P < 0.05)。结论 前列腺癌根治性切除术后首次血清PSA水平主要受患者BMI、T分期、术前PSA水平、精囊侵犯情况及神经侵犯情况的影响。
-
关键词:
- 前列腺癌 /
- 根治性切除术 /
- 术后首次前列腺特异性抗原水平 /
- 影响因素
Abstract: Objective To investigate the factors that affect the first serum PSA level after radical prostate cancer resection.Methods Two hundred and fifty-one prostate cancer patients who underwent radical resection in Northern Theater General Hospital from January 2015 to August 2021 were selected for retrospective analysis. The clinical data that may affect the changes of PSA level in the first serum after radical prostatectomy were collected. According to the results of the first PSA examination at 6-8 weeks after operation, the patients were divided into PSA < 0.2 ng/mL group and PSA≥0.2 ng/mL group, and the clinical treatment of the two groups were compared. The comprehensive effect of various factors on PSA level after radical resection was evaluated by the binary logistic regression method.Results A total of 56 patients from 251 patients had serum PSA≥0.2 ng/mL. The results of multivariate analysis showed that: increased BMI index, T stage of Ⅲ-Ⅳ, increased pre-PSA level, seminal vesicle invasion and nerve invasion were the risk factors for increased PSA level after radical prostatectomy (P < 0.05).Conclusion The first serum PSA level after radical prostate cancer resection is mainly affected by the patient's BMI index, T stage, preoperative PSA level, seminal vesicle invasion and nerve invasion. -
-
表 1 前列腺癌根治性切除术后首次血清PSA水平的单因素分析
例，X±S 因素 PSA≥0.2 ng/mL组
(n=56)PSA < 0.2 ng/mL组
(n=195)χ2/t P值 年龄/岁 56.72±7.88 57.09±8.07 -0.304 0.761 BMI/(kg·m-2) 25.83±4.02 23.67±3.85 3.664 0 T分期(Ⅰ~Ⅱ期/Ⅲ~Ⅳ期) 30/26 149/46 11.093 0.001 高血压病史(无/有) 15/41 41/154 0.833 0.361 糖尿病史(无/有) 43/13 157/38 0.373 0.541 吸烟史(无/有) 35/21 133/62 0.640 0.424 饮酒史(无/有) 43/13 144/51 0.198 0.656 术前PSA水平/(ng·mL-1) 32.19±7.03 12.68±2.71 31.549 0 术前Gleason评分/分 8.85±2.09 7.96±2.11 2.788 0.006 术前血红蛋白水平/(g·L-1) 85.17±19.27 113.28±24.02 -8.042 0 前列腺体积/mL 35.28±7.03 32.72±7.64 2.249 0.025 肿瘤最大径/cm 4.61±1.03 3.58±1.05 6.497 0 精囊侵犯情况(无/有) 16/40 29/166 5.549 0.018 淋巴转移情况(无/有) 35/21 156/39 7.325 0.007 神经周围侵犯情况(无/有) 13/43 21/174 5.754 0.016 血管侵犯情况(无/有) 11/45 17/178 5.239 0.022 术前新辅助化疗情况(无/有) 50/6 186/9 2.880 0.090 术后新辅助化疗情况(无/有) 49/7 142/53 5.154 0.023 
下载: 导出CSV
表 2 各因素赋值情况
因素 赋值 BMI/(kg·m-2) 原值代入 T分期 Ⅰ~Ⅱ期=0，Ⅲ~Ⅳ期=1 术前PSA水平/(ng·mL-1) 原值代入 术前Gleason评分/分 原值代入 术前血红蛋白水平/(g·L-1) 原值代入 前列腺体积/mL 原值代入 肿瘤最大径/cm 原值代入 精囊侵犯情况 否=0，是=1 淋巴转移情况 否=0，是=1 神经周围侵犯情况 否=0，是=1 血管侵犯 否=0，是=1 术后新辅助化疗情况 无=0，有=1
下载: 导出CSV
表 3 前列腺癌根治性切除术后首次血清PSA水平的多因素分析
变量 β S.E Wald P值 OR值 95%CI 下限 上限 BMI增加 0.375 0.184 4.154 0.027 1.455 1.014 2.087 T分期为Ⅲ~Ⅳ期 0.406 0.176 5.321 0.008 1.501 1.063 2.119 术前PSA水平升高 0.415 0.183 5.143 0.011 1.514 1.058 2.168 术前Gleason评分升高 0.365 0.191 3.652 0.057 1.441 0.991 2.095 术前血红蛋白水平升高 -0.319 0.185 2.973 0.121 0.727 0.506 1.045 前列腺体积增加 0.326 0.182 3.208 0.083 1.385 0.970 1.979 肿瘤最大径增加 0.375 0.195 3.698 0.055 1.455 0.993 2.132 精囊侵犯 0.414 0.167 6.146 0 1.513 1.091 2.099 淋巴转移 0.311 0.179 3.019 0.094 1.365 0.961 1.938 血管侵犯 0.372 0.191 3.793 0.051 1.451 0.998 2.109 神经周围侵犯 0.437 0.175 6.236 0 1.548 1.099 2.181 术后新辅助化疗 -0.281 0.174 2.608 0.157 0.755 0.537 1.062
下载: 导出CSV
-
[1] 李星, 曾晓勇. 中国前列腺癌流行病学研究进展[J]. 肿瘤防治研究, 2021, 48(1): 98-102. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLFY202101019.htm
[2] 高瑞松, 周青, 张晓波, 等. 湖南部分地区2877例前列腺癌患者临床流行病学特征及流行学趋势分析[J]. 中华男科学杂志, 2020, 26(4): 309-315. https://www.cnki.com.cn/Article/CJFDTOTAL-NKXB202004005.htm
[3] Pak S, You D, Jeong IG, et al. Time to biochemical relapse after radical prostatectomy and efficacy of salvage radiotherapy in patients with prostate cancer[J]. Int J Clin Oncol, 2019, 24(10): 1238-1246. doi: 10.1007/s10147-019-01463-5
[4] Horn T, Krönke M, Rauscher I, et al. Single lesion on prostate-specific membrane antigen-ligand positron emission tomography and low prostate-specific antigen are prognostic factors for a favorable biochemical response to prostate-specific membrane antigen-targeted radioguided surgery in recurrent prostate cancer[J]. Eur Urol, 2019, 76(4): 517-523. doi: 10.1016/j.eururo.2019.03.045
[5] 王子威, 连碧珺, 李晶, 等. 基于术后短期PSA变化的前列腺癌根治术后生化复发预测模型及其验证[J]. 临床泌尿外科杂志, 2021, 36(6): 454-457. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW202106006.htm
[6] Marconi L, Stonier T, Tourinho-Barbosa R, et al. Robot-assisted radical prostatectomy after focal therapy: oncological, functional outcomes and predictors of recurrence[J]. Eur Urol, 2019, 76(1): 27-30. doi: 10.1016/j.eururo.2019.03.007
[7] Lohm G, Neumann K, Budach V, et al. Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy: Prolongation of prostate-specific antigen doubling time in patients with subsequent biochemical progression[J]. Strahlenther Onkol, 2018, 194(4): 325-332. doi: 10.1007/s00066-017-1247-1
[8] Frenzel T, Tienken M, Abel M, et al. The impact of[68 Ga]PSMA I & T PET/CT on radiotherapy planning in patients with prostate cancer[J]. Strahlenther Onkol, 2018, 194(7): 646-654. doi: 10.1007/s00066-018-1291-5
[9] Bourbonne V, Fournier G, Vallières M, et al. External Validation of an MRI-Derived Radiomics Model to Predict Biochemical Recurrence after Surgery for High-Risk Prostate Cancer[J]. Cancers(Basel), 2020, 12(4): 814-829.
[10] Sun G, Huang R, Zhang X, et al. The impact of multifocal perineural invasion on biochemical recurrence and timing of adjuvant androgen-deprivation therapy in high-risk prostate cancer following radical prostatectomy[J]. Prostate, 2017, 77(12): 1279-1287. doi: 10.1002/pros.23388
[11] Altok M, Troncoso P, Achim MF, et al. Prostate cancer upgrading or downgrading of biopsy Gleason scores at radical prostatectomy: prediction of "regression to the mean" using routine clinical features with correlating biochemical relapse rates[J]. Asian J Androl, 2019, 21(6): 598-604. doi: 10.4103/aja.aja_29_19
[12] Fujimoto N, Shiota M, Tomisaki I, et al. Reconsideration on clinical benefit of pelvic lymph node dissection during radical prostatectomy for clinically localized prostate cancer[J]. Urol Int, 2019, 103(2): 125-136. doi: 10.1159/000497280
[13] Saika T, Miura N, Fukumoto T, et al. Role of robot-assisted radical prostatectomy in locally advanced prostate cancer[J]. Int J Urol, 2018, 25(1): 30-35. doi: 10.1111/iju.13441
[14] De Bari B, Mazzola R, Aiello D, et al. Could 68-Ga PSMA PET/CT become a new tool in the decision-making strategy of prostate cancer patients with biochemical recurrence of PSA after radical prostatectomy? A preliminary, monocentric series[J]. Radiol Med, 2018, 123(9): 719-725. doi: 10.1007/s11547-018-0890-7
[15] Saad F, Latour M, Lattouf J B, et al. Biopsy based proteomic assay predicts risk of biochemical recurrence after radical prostatectomy[J]. J Urol, 2017, 197(4): 1034-1040. doi: 10.1016/j.juro.2016.09.116
[16] Gandaglia G, Briganti A, Clarke N, et al. Adjuvant and salvage radiotherapy after radical prostatectomy in prostate cancer patients[J]. Euro Urol, 2017, 72(5): 689-709.
[17] Fujimoto N, Shiota M, Tomisaki I, et al. Reconsideration on clinical benefit of pelvic lymph node dissection during radical prostatectomy for clinically localized prostate cancer[J]. Urol Int, 2019, 103(2): 125-136. doi: 10.1159/000497280
[18] Hennequin C, Hannoun-Lévi JM, Rozet F. Management of local relapse after prostate cancer radiotherapy: Surgery or radiotherapy?[J]. Cancer Radiother, 2017, 21(6-7): 433-436.
[19] Ciriaco P, Briganti A, Bernabei A, et al. Safety and early oncologic outcomes of lung resection in patients with isolated pulmonary recurrent prostate cancer: A single-center experience[J]. Euro Urol, 2019, 75(5): 871-874.
[20] Einspieler I, Rauscher I, Düwel C, et al. Detection efficacy of hybrid 68Ga-PSMA ligand PET/CT in prostate cancer patients with biochemical recurrence after primary radiation therapy defined by Phoenix criteria[J]. J Nucl Med, 2017, 58(7): 1081-1087.
-