Significance of NLR, MRI, p2PSA, and PHI in the diagnosis of prostate cancer with PSA between 4 and 20 ng/mL
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摘要: 目的 探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio，NLR)、核磁共振成像(magnetic resonance imaging，MRI)、血清前列腺特异性抗原同源异构体2(serum prostate-specific antigen isoform 2，p2PSA)及其相关指标前列腺健康指数(prostate health index，PHI)在PSA介于4~20 ng/mL之间的前列腺癌(prostate cancer，PCa)诊断过程中的价值。方法 选取2021年1月—2022年1月嘉兴市第一医院前列腺穿刺患者342例，符合入组条件的205例，分为PCa组(96例)和良性前列腺增生(benign prostatic hyperplasia，BPH)组(109例)。在PCa患者的亚组分析中，根据病理Gleason评分，将PCa患者分为高危组(36例)和非高危组(60例)。检测患者血清总前列腺特异性抗原(total prostate specific antigen，tPSA)、p2PSA、游离前列腺特异性抗原(free prostate specific antigen，fPSA)水平，计算出PHI。检测血常规，根据中性粒细胞值及淋巴细胞值，计算出NLR值，比较各组指标的差异。结果 PCa组血清tPSA、MRI、p2PSA和PHI水平高于BPH组，差异有统计学意义(P＜0.05)；PCa组血清NLR水平低于BPH组，差异有统计学意义(P＜0.05)；受试者工作特征(receiver operating characteristic，ROC)曲线分析结果显示，tPSA、NLR、MRI、p2PSA、PHI诊断PCa的曲线下面积(area under curve，AUC)分别为0.605、0.591、0.597、0.617、0.820；联合诊断方案中PHI+MRI、PHI+NLR、PHI+p2PSA、PHI+p2PSA+MRI、PHI+p2PSA+NLR、PHI+MRI+NLR方案的AUC均大于0.820，检测效能大于各指标单独检测，其中PHI+MRI+NLR方案最好(AUC=0.844)。在亚组分析中，高危PCa组tPSA、MRI、NLR和PHI水平高于非高危PCa组，差异有统计学意义(P＜0.05)。结论 p2PSA和PHI对PSA介于4~20 ng/mL之间的诊断价值优于tPSA，可作为PCa更好的临床辅助诊断指标，PHI+MRI+NLR对PCa的联合诊断效能更高，可以弥补单项指标诊断的不足，提高PCa的检出率，降低漏诊率。tPSA、NLR、PHI能够预测PCa风险程度，NLR预测PCa的预后价值高于其诊断价值，但是NLR在PCa的诊断价值和预测PCa预后价值均低于tPSA。
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关键词:
- 前列腺癌 /
- 前列腺特异性抗原同源异构体2 /
- 前列腺健康指数 /
- 中性粒细胞/淋巴细胞比值
Abstract: Objective To explore the value of neutrophil to lymphocyte ratio(NRL), magnetic resonance imaging(MRI), serum prostate-specific antigen isoform 2(p2PSA) and its related index prostate health index(PHI) in the diagnosis of prostate cancer(PCa) with PSA between 4 and 20 ng/mL.Methods A total of 342 patients with prostate biopsy in Jiaxing First Hospital between Jan 2021 and Jan 2022 were selected, and 205 patients meeting the enrollment conditions were selected as PCa group(96 cases) and benign prostatic hyperplasia(BPH) group(109 cases), respectively. In subgroup analysis of PCa patients, PCa patients were divided into high risk group(36 cases) and non-high risk group(60 cases) according to pathological Gleason score. The serum levels of total prostate specific antigen(tPSA), p2PSA and free prostate specific antigen(fPSA) were detected to calculate the PHI. By blood routine examination, NLR was calculated according to neutrophil and lymphocyte values, and the differences among all groups were compared.Results Serum levels of tPSA, MRI, p2PSA and PHI were higher in the PCa group than in the BPH group, and the difference was statistically significant(P < 0.05), The serum NLR level in PCa group was lower than that in BPH group, and the difference was statistically significant(P < 0.05). The results of the ROC curve analysis showed that the areas under the curve(AUC) for tPSA, NLR, MRI, p2PSA and PHI were 0.605, 0.591, 0.597, 0.617, and 0.820 respectively; The AUC of PHI+MRI, PHI+NLR, PHI+p2PSA, PHI+p2PSA+MRI, PHI+p2PSA+NLR, PHI+MRI+NLR in the combined diagnostic scheme were all greater than 0.820, and the detection efficiency was greater than that of each index alone. The PHI+MRI+NLR scheme was the best(AUC=0.844). In subgroup analysis, the levels of tPSA, MRI, NLR and PHI in high-risk PCa group were higher than those in non-high-risk PCa group, with statistical significance(P < 0.05).Conclusion The diagnostic value of p2PSA and PHI for PSA between 4 and 20 ng/mL is better than that of tPSA, so they can be used as better clinical auxiliary diagnosis indexes of PCa. The combination of PHI, MRI and NLR has higher diagnostic efficiency for PCa, which can make up for the deficiency of each individual indicator, improve the detection rate of PCa and reduce the rate of missed diagnosis. TPSA, NLR, p2PSA and PHI can predict the risk degree of PCa. The prognostic value of NLR in predicting PCa is higher than its diagnostic value, but the diagnostic value and prognostic value of NLR in predicting PCa are lower than those of tPSA. -
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表 1 PCa组和BPH组各项指标检测结果比较
X±S，M(P25，P75) 指标 PCa组(96例) BPH组(109例) t/z P值 年龄/岁 71.98±6.93 67.61±6.94 4.50 ＜0.001 tPSA/(ng/mL) 8.86(6.44，13.61) 7.54(5.46，10.61) -2.60 0.009 fPSA/(ng/mL) 1.01(0.65，1.53) 1.17(0.75，1.62) -1.46 0.146 p2PSA/(ng/mL) 22.82(15.37，35.55) 19.41(11.21，26.35) -2.90 0.004 PHI 69.29(53.42，90.43) 42.90(33.90，55.29) -7.91 ＜0.001 NLR 2.74(2.05，3.47) 3.08(2.23，4.38) -2.25 0.024 
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表 2 各检测指标对PCa诊断的效能
指标 AUC(95%CI) P值 cut-off值 灵敏度/% 特异度/% 约登指数 tPSA 0.605(0.535~0.673) 0.008 9.91 47.92 72.48 0.204 fPSA 0.559(0.488~0.628) 0.144 1.10 56.25 56.88 0.131 MRI 0.597(0.526~0.665) 0.002 - 78.12 41.28 0.194 NLR 0.591(0.521~0.659) 0.021 3.14 70.83 48.62 0.195 p2PSA 0.617(0.547~0.684) 0.002 28.00 39.58 79.82 0.194 PHI 0.820(0.761~0.870) ＜0.001 59.36 66.67 86.24 0.529 PHI+MRI 0.832(0.774~0.881) ＜0.001 0.37 78.12 76.15 0.543 PHI+p2PSA 0.825(0.766~0.874) ＜0.001 0.35 87.50 63.30 0.508 PHI+NLR 0.831(0.773~0.880) ＜0.001 0.52 66.67 86.24 0.529 PHI+p2PSA+MRI 0.836(0.779~0.884) ＜0.001 0.41 78.12 79.82 0.579 PHI+p2PSA+NLR 0.839(0.782~0.887) ＜0.001 0.36 87.50 66.97 0.545 PHI+MRI+NLR 0.844(0.787~0.891) ＜0.001 0.38 83.33 72.48 0.558
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表 3 高危PCa组和非高危PCa组各项指标检测结果比较
X±S，M(P25，P75) 指标 高危PCa组(36例) 非高危PCa组(60例) t/z P值 年龄/岁 74.19±7.35 70.65±6.36 2.49 0.014 tPSA/(ng/mL) 11.37(7.29，15.55) 7.76(5.58，12.04) -2.93 0.003 p2PSA/(ng/mL) 28.22(17.12，39.09) 20.97(13.09，32.13) -1.70 0.089 PHI 80.68(56.75，123.30) 64.40(51.85，82.20) -2.64 0.008 NLR 6.43(5.10，10.23) 9.23(5.89，12.33) -2.37 0.018
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表 4 采用logistic回归模型建立多个指标联合诊断对PCa的诊断效能及预测模型的拟合结果
指标 B SE Wald df P值 Exp(B) Exp(B)的95%置信区间 下限 上限 MRI 0.885 0.370 5.725 1 0.017 2.423 1.174 5.004 PHI 0.058 0.010 34.776 1 ＜0.001 1.059 1.039 1.080 NLR -0.348 0.141 6.009 1 0.014 0.706 0.536 0.931 常量 -2.975 0.703 17.920 1 ＜0.001 0.051
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[1] 潘剑, 朱耀, 戴波, 等. 2022年度前列腺癌基础研究及临床诊疗新进展[J]. 中国癌症杂志, 2023, 33(3): 210-217. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ202303003.htm
[2] 朱刚, 张凯. 中国前列腺癌筛查的现状和挑战[J]. 山东大学学报(医学版), 2019, 57(1): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYB201901008.htm
[3] 肖凤. 经直肠超声联合磁共振成像对前列腺癌的早期诊断价值[J]. 实用医技杂志, 2022, 29(8): 867-869. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYJ202208024.htm
[4] Terada N, Akamatsu S, Kobayashi T, et al. Prognostic and predictive biomarkers in prostate cancer: latest evidence and clinical implications[J]. Ther Adv Med Oncol, 2017, 9(8): 565-573. doi: 10.1177/1758834017719215
[5] 谭智勇, 付什, 左桀明, 等. 前列腺健康指数在前列腺癌诊疗中的研究进展[J]. 中华泌尿外科杂志, 2023, 44(3): 234-236. https://www.cnki.com.cn/Article/CJFDTOTAL-NBYX202110068.htm
[6] 蒋凯峰, 雷震, 朴敏虎, 等. 前列腺健康指数在前列腺穿刺选择中的价值[J]. 现代泌尿外科杂志, 2020, 25(9): 813-815. doi: 10.3969/j.issn.1009-8291.2020.09.012
[7] Qi WX, Xiang Y, Zhao S, et al. Assessment of systematic inflammatory and nutritional indexes in extensive-stage small-cell lung cancer treated with first-line chemotherapy and atezolizumab[J]. Cancer Immunol Immunother, 2021, 70(11): 3199-3206. doi: 10.1007/s00262-021-02926-3
[8] 赵硕, 李望. 前列腺特异性抗原联合胱抑素C和中性粒细胞淋巴细胞比值在前列腺癌中的诊断作用[J]. 中华实验外科杂志, 2020, 37(8)1437-1411.
[9] 路惠茹, 梁亮, 谢宏俊, 等. 前列腺特异性抗原同源异构体2及其衍生指标对PSA 4~20 ng/mL患者前列腺癌的预测价值[J]. 现代泌尿外科杂志, 2023, 28(4): 347-350, 358. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK202304016.htm
[10] 潘良明, 沈菲菲, 马晓英, 等. 血清前列腺健康指数对tPSA灰区前列腺癌患者的诊断价值探讨[J]. 现代检验医学杂志, 2021, 36(1): 72-76, 99. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYN202101020.htm
[11] Chiu PK, Ng CF, Semjonow A, et al. A Multicentre Evaluation of the Role of the Prostate Health Index(PHI)in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings[J]. Eur Urol, 2019, 75(4): 558-561.
[12] 中国抗癌协会泌尿男生殖系统肿瘤专业委员会前列腺癌学组, 戴波, 叶定伟, 等. 前列腺癌筛查中国专家共识(2021年版)[J]. 中国癌症杂志, 2021, 31(5): 435-440. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZL202202002.htm
[13] 王宝华, 沙宇婷, 何凤蝶, 等. 前列腺特异性抗原对中国人群前列腺癌早期检测价值的Meta分析[J]. 中国癌症杂志, 2020, 30(11): 879-886. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ202011006.htm
[14] 韩磊, 王辉, 钱磊, 等. HMGB1和PSA联合检测对前列腺癌诊断价值的研究[J]. 检验医学与临床, 2021, 18(5): 625-627, 631. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202105015.htm
[15] 韩卫, 赵亚琦, 张兰胜, 等. 游离和总前列腺特异性抗原比值、外周血中性粒细胞和淋巴细胞比值、白细胞介素6、前列腺健康指数密度检测在前列腺癌早期诊断中的应用[J]. 肿瘤研究与临床, 2023, 35(6): 439-444.
[16] 陈一鹏, 徐仁芳, 许贤林, 等. 血小板淋巴细胞比和中性粒细胞淋巴细胞比对前列腺癌内分泌治疗后早期去势抵抗预测价值的研究[J]. 中华泌尿外科杂志, 2017, 38(2): 110-114.
[17] 黄宜, 王文涓, 许静, 等. p2PSA及其相关指标PHI在前列腺癌诊断中的应用价值[J]. 检验医学, 2019, 34(7): 600-604. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYY201907006.htm
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