Distribution of influencing factors of postoperative biochemical recurrence in prostate cancer patients with different PSA levels based on latent class analysis
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摘要: 目的 探讨基于潜在类别分析的不同前列腺特异性抗原(PSA)水平前列腺癌(PCa)患者术后生化复发影响因素分布特征。方法 选择2016年10月—2021年11月于粤北人民医院收治的155例PCa患者为研究对象。将纳入患者按照术后是否生化复发，分为复发组(43例)和非复发组(112例)。比较两组临床资料，采用多因素logistic回归模型分析患者术后生化复发的影响因素。使用潜在类别分析法比较高风险与低风险间的分布特征差异。结果 术前Gleason评分、术后Gleason评分、精囊侵犯、淋巴结侵犯、切缘阳性、术前PSA水平均为患者生化复发的独立危险因素(P < 0.05)，且6个影响因素的分布具有明显差异。聚类分析结果将研究对象分为复发高风险组(PSA≥20 μg/L，20例，复发发生率12.90%)和复发低风险组(PSA < 20 μg/L，23例，复发发生率14.84%)。潜在类别结果显示，高风险组的2个潜在类别的概率为46.02%、46.45%，低风险组的2个潜在类别的概率为45.00%、45.43%。结论 不同PSA水平的PCa患者术后生化复发情况在术前Gleason评分、术后Gleason评分、精囊侵犯、淋巴结侵犯、切缘阳性、术前PSA水平的因素值得临床深入探究。另外，本文通过潜在类别分析发现，患者术后生化复发的高风险和低风险人群在以上影响因素的分布特征中具有显著差异。Abstract: Objective To explore the distribution characteristics of factors influencing postoperative biochemical recurrence in prostate cancer patients with different PSA levels based on latent class analysis.Methods A total of 155 patients with prostate cancer who were admitted to North Guangdong People's Hospital from October 2016 to November 2021 were selected as the research subjects. The included patients were divided into recurrence group (n=43) and non-recurrence group (n=112) according to whether there was biochemical recurrence after surgery. The clinical data of the two groups were compared, and the multivariate logistic regression model was used to analyze the influencing factors of postoperative biochemical recurrence. Differences in distribution characteristics between high and low risk were compared using latent class analysis.Results Preoperative Gleason score, postoperative Gleason score, seminal vesicle invasion, lymph node invasion, positive resection margin, and preoperative PSA level were all independent risk factors for biochemical recurrence (P < 0.05), and the distribution of the six influencing factors was significantly different. Cluster analysis results divided the research subjects into a high-risk group (PSA≥20 μg/L, 20 patients, with a recurrence rate of 12.90%) and a low-risk group (PSA < 20 μg/L, 23 patients, with a recurrence rate of 14.84%). The latent category results showed that the probabilities of the two latent categories in the high-risk group were 46.02% and 46.45%, and the probabilities of the two latent categories in the low-risk group were 45.00% and 45.43%.Conclusion The factors of postoperative biochemical recurrence of prostate cancer patients with different PSA levels, including preoperative Gleason score, postoperative Gleason score, seminal vesicle invasion, lymph node invasion, positive resection margin, and preoperative PSA level, are worthy of further clinical investigation. In addition, this paper found that the distribution characteristics of the above influencing factors were significantly different between the high-risk and low-risk groups of patients with postoperative biochemical recurrence through latent category analysis.
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表 1 患者术后BCR的单因素分析
例(%)，X±S 因素 复发组(n=43) 非复发组(n=112) t/χ2 P值 年龄 65.29±6.33 65.91±6.59 0.530 0.298 Gleason评分/分 术前 7.36±1.09 6.79±1.23 2.663 0.004 术后 7.85±1.23 6.98±1.36 3.658 ＜0.001 临床表现 0.036 0.291 排尿不尽 6(13.95) 17(15.18) 排尿费力 10(23.26) 29(25.89) 尿频 18(41.86) 52(46.43) 尿急 9(20.93) 14(12.50) 病理分期 0.101 0.321 T2 34(79.07) 90(80.36) T3 6(13.95) 19(16.96) T4 3(6.98) 3(2.68) 临床分期 0.027 0.627 T2 10(23.26) 27(24.11) T3 26(60.47) 70(62.50) T4 7(16.28) 15(13.39) 精囊 7.504 0.006 侵犯 14(32.56) 15(13.39) 未侵犯 29(67.44) 97(86.61) 淋巴结 14.653 ＜0.001 侵犯 10(23.26) 4(3.57) 未侵犯 33(76.74) 108(96.43) 切缘 23.567 ＜0.001 阳性 16(37.21) 7(6.25) 阴性 27(62.79) 105(93.75) BMI/(kg·m-2) 0.001 0.977 ≤23 12(27.91) 31(27.68) ＞23 31(72.09) 81(72.32) 工作状态 0.001 0.975 退休 36(83.72) 94(83.93) 工作 7(16.28) 18(16.07) 教育程度 0.203 0.069 小学 21(48.84) 55(49.11) 初中 15(34.88) 38(33.93) 高中及以上 7(16.28) 19(16.96) 实验室指标 FIB/(g·L-1) 4.02±0.73 4.13±1.05 0.771 0.221 Scr/(μmol·L-1) 728.47±39.69 728.87±38.31 0.060 0.476 UA/(μmol·L-1) 488.58±20.35 489.25±19.32 0.203 0.420 TC/(mmol·L-1) 4.46±1.72 4.34±1.81 0.369 0.356 TG/(mmol·L-1) 1.43±0.85 1.37±0.63 0.388 0.349 HDL-C/(mmol·L-1) 1.08±0.74 1.12±0.95 0.295 0.384 LDL-C/(mmol·L-1) 2.28±0.52 2.31±0.54 0.344 0.366 K+/(mmol·L-1) 4.47±0.87 4.51±0.93 0.269 0.394 Ca+/(mmol·L-1) 2.06±0.35 2.11±0.41 0.487 0.313 血磷/(mmol·L-1) 1.49±0.22 1.42±0.23 1.640 0.051 术前PSA/(μg·L-1) 51.32±11.26 21.61±6.33 20.721 ＜0.001 
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表 2 影响患者预后的多因素分析
项目 β SE Wald χ2 OR 95%CI P值 术前Gleason评分 0.618 0.103 9.281 1.856 1.031~3.621 ＜0.001 术后Gleason评分 0.648 0.195 11.048 1.912 1.112~3.924 0.002 精囊侵犯 0.960 0.234 16.835 2.612 1.361~3.991 0.001 淋巴结侵犯 0.846 0.226 14.023 2.331 1.321~4.628 ＜0.001 切缘阳性 0.701 0.201 12.167 2.016 1.552~4.861 ＜0.001 术前PSA≥51.32 μg/L 1.182 0.314 14.171 3.261 2.394~5.612 0.001
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表 3 患者术后BCR风险研究结果
例 PSA/(μg·L-1) 例数 复发患者 非复发患者 BCR发生率/% χ2 P值 ≤10 61 12 49 19.67 3.268 0.041 11~13 11 2 9 18.18 2.540 0.002 14~16 14 4 10 28.57 3.951 0.001 17~19 21 5 16 23.81 3.941 0.001 ≥20 48 20 28 41.67 5.231 0.002
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表 4 潜在类别模型分析因素
编号 研究因素 序号1 序号2 A 术前Gleason评分 否 是 B 术后Gleason评分 否 是 C 精囊侵犯 否 是 D 淋巴结侵犯 否 是 E 切缘阳性 否 是 F 术前PSA水平≥51.32 μg/L 否 是
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表 5 术后BCR的高风险和低风险影响因素LCA指标比较
组别 G2 AIC BIC aBIC Entropy df 复发高风险组 cluster 1 956.9 8745.0 8803.8 8766.8 1.2 766.5 cluster 2 468.3 8312.0 8490.0 8342.6 1.3 753.0 cluster 3 582.2 8403.6 8525.4 8430.5 1.1 735.0 cluster 4 390.6 8274.8 8534.4 8344.8 1.1 724.5 cluster 5 353.4 8261.0 8573.0 8367.2 1.1 714.0 复发低风险组 cluster 1 867.5 7928.8 7982.1 7948.5 1.1 695.0 cluster 2 424.6 7536.2 7697.6 7563.9 1.2 682.7 cluster 3 527.8 7619.3 7729.7 7643.6 1.0 666.4 cluster 4 354.1 7502.4 7737.9 7566.0 1.0 656.9 cluster 5 320.4 7489.9 7772.8 7586.2 1.0 647.4
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表 6 BCR高风险和低风险的研究因素的条件概率和潜在类别概率
因素 序号 复发高风险潜在类别分布模式 复发低风险潜在类别分布模式 Latent Class 1 Latent Class 2 Latent Class 1 Latent Class 2 A 1 0.713 0.435 0.698 0.425 2 0.197 0.475 0.192 0.465 B 1 0.894 0.869 0.874 0.850 2 0.016 0.041 0.016 0.040 C 1 0.705 0.380 0.690 0.372 2 0.205 0.530 0.200 0.518 D 1 0.910 0.055 0.890 0.053 2 0.000 0.855 0.000 0.837 E 1 0.820 0.108 0.802 0.106 2 0.090 0.802 0.088 0.784 F 1 0.820 0.353 0.802 0.345 2 0.152 0.671 0.149 0.656
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