游离前列腺特异性抗原密度联合PI-RADS v2.1评分对PSA 4~20 ng/mL临床有意义前列腺癌的诊断价值

李彬; 张强; 刘成霏; 刘亚东

doi:10.13201/j.issn.1001-1420.2023.08.006

游离前列腺特异性抗原密度联合PI-RADS v2.1评分对PSA 4~20 ng/mL临床有意义前列腺癌的诊断价值

- 1.
  盐城市第三人民医院(东南大学医学院附属盐城医院)超声科(江苏盐城，224001)
- 2.
  盐城市第三人民医院(东南大学医学院附属盐城医院)泌尿外科

详细信息

通讯作者: 李彬，E-mail：libin198177@163.com

中图分类号: R737.25

收稿日期: 2022-12-12

刊出日期: 2023-08-06

Diagnostic value of free prostate specific antigen density combined with PI-RADS v2.1 for clinically significant prostate cancer with PSA 4-20 ng/mL

- 1.
  Department of Ultrasound, Yancheng Third People's Hospital, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, 224001, China
- 2.
  Department of Urology, Yancheng Third People's Hospital, Affiliated Yancheng Hospital, School of Medicine, Southeast University

More Information

Corresponding author: LI Bin, E-mail: libin198177@163.com

Received Date: 12 December 2022

Publish Date: 06 August 2023

摘要

摘要: 目的评估游离前列腺特异性抗原密度(free prostate specific antigen density，fPSAD)联合前列腺影像报告和数据系统(PI-RADS)v2.1在PSA 4~20 ng/mL时对前列腺穿刺结果为临床有意义前列腺癌(csPCa)的诊断价值。方法回顾性分析2016年1月—2022年9月于盐城市第三人民医院PSA检测结果为4~20 ng/mL行前列腺穿刺的179例患者的临床资料，其中，临床有意义前列腺癌组71例(csPCa组)，非临床有意义前列腺癌组108例(ncsPCa组)。根据PI-RADS v2.1对MRI图像进行评分，根据公式计算出前列腺体积(PV)和fPSAD；采用单因素及多因素logistic回归分析，得出csPCa的独立危险因素，绘制受试者工作特征(ROC)曲线，通过ROC曲线评估各因素单独及联合应用诊断csPCa的效能。最后绘制列线图，为临床应用该预测模型提供参考。结果入组患者的游离前列腺特异性抗原(fPSA)、PV、fPSAD和PI-RADS v2.1评分差异均有统计学意义(P < 0.05)。fPSAD(OR=1.51，95%CI：1.51~1.84，P < 0.05)和PI-RADS v2.1评分(OR=2.63，95%CI：2.63~4.00，P < 0.05)是csPCa的独立危险因素。fPSAD联合PI-RADS v2.1评分诊断csPCa的ROC曲线下面积(AUC)为0.82，显著优于PI-RADS v2.1评分和fPSAD单独应用(AUC均为0.75)，差异均有统计学意义(P < 0.05)。结论对PSA 4~20 ng/mL患者，fPSAD、PI-RADS v2.1评分对csPCa有一定的诊断价值，两者联合应用可以提高其诊断效能。
- 游离前列腺特异性抗原密度 /
- 前列腺成像报告和数据系统v2.1 /
- 临床有意义前列腺癌 /
- 诊断
Abstract: Objective To evaluate the diagnostic value of free prostate specific antigen density(fPSAD) combined with prostate imaging reporting and data system(PI-RADS) v2.1 for prostate puncture results as clinically significant prostate cancer(csPCa) at PSA 4-20 ng/mL.Methods The clinical data of PSA 4-20 ng/mL patients undergoing prostate biopsy in our hospital from January 2016 to September 2022 were retrospectively analyzed, including 71 patients with clinically significant prostate cancer(csPCa group) and 108 patients with non-clinically significant prostate cancer(ncsPCa group). MRI images were scored according to PI-RADS v2.1, and prostate volume(PV) and free prostate specific antigen density(fPSAD) were calculated according to the formula. The independent risk factors of csPCa were obtained by univariate and multivariate logistic regression analyses, and the receiver operating characteristic(ROC) curve of subjects was drawn. The effectiveness of each factor independently and jointly diagnosing csPCa were evaluated by the ROC curve. Finally, a column chart to provide reference for the clinical application of this prediction model was drawn.Results There were significant differences in free prostate specific antigen(fPSA), PV, fPSAD and PI-RADS v2.1 score among the enrolled patients(all P < 0.05). FPSAD(OR=1.51, 95%CI: 1.51-1.84, P < 0.05) and PI-RADS v2.1 score(OR=2.63, 95%CI: 2.63-4.00, P < 0.05) were independent risk factors for csPCa. The area under the ROC curve(AUC) for the combination of PI-RADS v2.1 score and fPSAD was 0.82, which is significantly superior to using PI-RADS v2.1 score or fPSAD alone(both were 0.75). The difference was statistically significant(P < 0.05).Conclusion For patients with PSA 4-20 ng/mL, fPSAD, PI-RADS v2.1 score have certain diagnostic value in csPCa, and the combination of the two can improve its diagnostic efficacy.
- free prostate specific antigen density /
- prostate imaging reporting and data system v2.1 /
- clinically significant prostate cancer /
- diagnosis

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图 1 fPSAD和PI-RADS v2.1独立诊断和联合诊断csPCa的ROC曲线

下载: 全尺寸图片幻灯片

图 2 联合fPSAD和PI-RADS v2.1预测csPCa的列线图

下载: 全尺寸图片幻灯片

表 1 患者基线资料表 X±S，M(P₂₅，P₇₅)

变量	总计(179例)	ncsPCa组(108例)	csPCa组(71例)	P值
年龄/岁	72.28±7.85	73.11±7.86	71.03±7.67	0.083
BMI/(kg/m²)	23.65±3.63	23.50±3.65	23.89±3.57	0.475
PI-RADS	3(3，4)	3(2，4)	4(4，4)	< 0.001
fPSA/(ng/mL)	1.61(0.98，2.27)	1.41(0.93，2.17)	1.85(1.08，2.53)	0.023
tPSA/(ng/mL)	10.89(8.30，14.99)	11.17(7.89，15.09)	10.52(8.95，13.60)	0.694
PV/mL	52.17(39.55，75.82)	63.14(48.35，80.73)	42.60(33.94，53.35)	< 0.001
fPSAD	0.028(0.018，0.042)	0.023(0.015，0.032)	0.040(0.025，0.068)	< 0.001

下载: 导出CSV

表 2 单因素和多因素二元logistic回归分析

参数	标准系数	优势比(OR)	95% CI	P值
单因素logistic回归
tPSA	0.04	0.98	0.91~1.05	0.610
fPSA	0.16	1.47	1.08~2.05	0.020
PV	0.01	0.96	0.94~0.98	< 0.001
PI-RADS	0.19	2.76	1.92~4.12	< 0.001
fPSAD×100	0.09	1.54	1.31~1.87	< 0.001
多因素logistic回归
PI-RADS	0.20	2.63	2.63~4.00	< 0.001
fPSAD×100	0.09	1.51	1.51~1.84	< 0.001

下载: 导出CSV

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