切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 326 -331. doi: 10.3877/cma.j.issn.1674-3253.2023.04.003

临床研究

临床局限性前列腺癌包膜外侵犯的危险因素分析
穆靖军, 马增妮, 曹晓明†()   
  1. 030001　太原，山西医科大学第一医院泌尿外科
  • 收稿日期:2022-06-23 出版日期:2023-08-01
  • 通信作者: 曹晓明
  • 基金资助:
    山西省卫生健康委科研课题(No.2020087)

Analysis of risk factors for extraprostatic extension in clinically localized prostate cancer

Jingjun Mu, Zengni Ma, Xiaoming Cao†()   

  1. Department of Urology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2022-06-23 Published:2023-08-01
  • Corresponding author: Xiaoming Cao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

穆靖军, 马增妮, 曹晓明. 临床局限性前列腺癌包膜外侵犯的危险因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 326-331.

Jingjun Mu, Zengni Ma, Xiaoming Cao. Analysis of risk factors for extraprostatic extension in clinically localized prostate cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 326-331.

目的

分析临床局限性前列腺癌发生包膜外侵犯（EPE)的危险因素，以提高术前预测EPE的准确性。

方法

回顾性分析了2018年8月至2021年11月山西医科大学第一医院因临床局限性前列腺癌行根治术的222例患者临床资料。经单因素及多因素的logistic回归分析，探讨影响EPE的独立危险因素，并绘制受试者工作特征（ROC）曲线，计算并比较相关指标预测EPE的性能。

结果

前列腺穿刺阳性针数百分比（PBPC）和前列腺特异性抗原（PSA）为EPE的独立危险因素，曲线下面积分别为0.79（95%CI：0.73~0.84）、0.56（95%CI：0.49~0.62），其最佳截断值分别为57.14%和10.17 ng/ml。PBPC联合PSA较PBPC并没有提高诊断效能（P>0.05）。PBPC在非高危组患者中预测EPE的效能可能较高危组更佳（P=0.03），而PSA在两组中差异无统计学意义（P=0.14）。

结论

PBPC和PSA可能提高了术前预测临床局限性前列腺癌包膜外侵犯的准确性，尤其是对非高危的患者。PBPC与PSA截断值有益于制定术中是否保留神经血管束的手术决策。

关键词: 前列腺癌, 包膜外侵犯, 危险因素, 术前预测
Objective

To analysis of risk factors for extraprostatic extension (EPE) in clinically localized prostate cancer to improve the accuracy of preoperative prediction of EPE.

Methods

The clinical data of 222 patients who underwent radical prostatectomy for clinically localized prostate cancer in the First Hospital of Shanxi Medical University from August 2018 to November 2021 were retrospectively analyzed. Univariate and multivariate logistic regression analysis were performed to investigate the independent risk factors affecting EPE, and receiver operating characteristic (ROC) curves were plotted to calculate and compare the performance of relevant indicators in predicting EPE.

Results

The percentage of biopsy positive cores (PBPC) and prostate-specific antigen (PSA) were independent risk factors for EPE, with AUC values of 0.79 (95%CI: 0.73-0.84) and 0.56 (95%CI: 0.49-0.62), respectively, and their optimal cutoff values were 57.14% and 10.17 ng/mL, respectively. PBPC and PSA did not improve the diagnostic efficacy compared with PBPC only (P>0.05). PBPC had better power to predict EPE in patients in the non-high-risk group than in the high-risk group (P=0.03), while PSA did not differ between the two groups (P=0.14).

Conclusions

PBPC and PSA may improve the accuracy of preoperative prediction of extraprostatic extension in clinically localized prostate cancer, especially in non-high risk patients. PBPC and PSA cutoff values are useful in making surgical decisions whether to preserve neurovascular bundles (NVB) intraoperatively.

Key words: Prostate cancer, Extraprostatic extension, Risk factors, Preoperative Prediction
表1 纳入本研究222例前列腺癌患者的临床资料
项目 数值 项目 数值
年龄(岁) 69(64~74)0. 阳性针数 006.00(3.00~10.00)
PSA(ng/ml) 17.42(8.38~30.16) 穿刺ISUP评分  
前列腺体积(ml) 039.10(28.16~58.88) 1 54(24.32%)
PSAD[ng/(ml·ml)] 0.37(0.19~0.98) 2 39(17.57%)
PBPC 000041.67(21.43%~70.80%) 3 40(21.98%)
PI-RADS评分   4 39(17.57%)
≤2 16(7.21%)00 5 50(22.52%)
3 40(18.02%)0 RP后ISUP评分  
4 62(27.93%)0. 1 32(14.41%)
5 104(46.85%)0.0 2 47(21.17%)
穿刺至手术间隔(d) 18(12~34)00 3 47(21.17%)
手术方式   4 38(17.12%)
腹腔镜 84(37.84%)0 5 58(26.13%)
机器人 137(61.71%)00 淋巴结清扫  
开放 1(0.45%)0 未清扫 118(53.15%)
切缘   阳性 26(11.71%)
阳性 96(43.24%)0 阴性 78(35.14%)
阴性 126(56.76%)00 风险分组  
pT分期   低危 22(9.91%)0
<pT3 162(72.97%)00. 中危 61(27.48%)
≥pT3 60(27.03%)0. 高危 139(62.61%)0
表2 预测前列腺包膜外侵犯的影响因素分析
项目 OC组 EPE组 P值 项目 OC组 EPE组 P值
例数 162 60   PI-RADS评分     0.018
年龄(岁) 69(64~74) 68(64~73) 0.919 ≤2 14(8.6%)0 2(3.4%)  
PSA(ng/ml) 15(8~28)0 20(11~34) 0.194 3 33(20.4%) 07(11.7%)
4 49(30.2%) 13(21.7%)
PSAD[ng/(ml·ml)] 0.33(0.18~0.95) 0.51(0.22~1.05)0 0.1660 5 66(40.7%) 38(63.3%)
穿刺ISUP评分     0.001
阳性针数 5(2~7)0 11(6~12). <0.001 1 50(30.9%) 4(6.7%)  
PBPC 034(15~54)0 077(49~100) <0.0010 2 30(18.5%) 09(15.0%)
3 28(17.3%) 12(20.0%)
穿刺至手术间隔(d) 18(12~35) 0.17(10~33)0 0.298 4 26(16.0%) 13(21.7%)
5 28(17.3%) 22(36.7%)
切缘性质     <0.0010
手术方式     0.738 阳性 51(31.5%) 45(75.0%)  
腹腔镜 63(38.9%)0 21(35.0%).   阴性 111(68.5%) 15(25.0%)
机器人 98(60.5%)0 39(65.0%).     0    
表3 前列腺癌患者肿瘤是否包膜外侵犯的单因素和多因素分析
变量 单因素分析 P值 多因素分析 P值
OR 95%CI OR 95%CI
PSA 1.00 0.99~1.00 0.85 0.99 0.98~1.00 0.04
阳性针数 1.31 1.20~1.43 <0.001 0.98 0.74~1.29 0.87
PBPC 1.04 1.03~1.05 <0.001 1.04 1.00~1.08 0.04
PI-RADS评分            
1 参考 参考 - 参考 参考 -
2 1.74 00.11~28.57 0.70 1.92 00.10~36.09 0.66
3 0.13 0.02~1.06 0.06 0.53 0.05~5.31 0.59
4 0.37 0.15~0.91 0.03 1.08 0.33~3.48 0.90
5 0.46 0.22~0.96 0.04 0.64 0.28~1.49 0.31
穿刺ISUP评分            
1 参考 参考 - 参考 参考 -
2 0.10 0.03~0.33 <0.001 0.32 0.08~1.29 0.11
3 0.38 0.15~0.97 0.04 0.57 0.19~1.68 0.31
4 0.55 0.23~1.31 0.18 0.93 0.33~2.60 0.89
5 0.64 0.27~1.52 0.31 0.89 0.32~2.47 0.83
图1 PBPC、PSA、及PBPC+PSA预测EPE的ROC曲线
表4 不同指标评估预测前列腺肿瘤是否存在包膜外侵犯的性能
项目 AUC(95%CI) 敏感性(%) 特异性(%) 截断值 阳性预测值(%) 阴性预测值(%)
PBPC 0.79（0.73~0.84） 75.00 78.40 >57.14 56.35 89.44
PSA 0.56（0.49~0.62） 78.33 35.80 >10.17 31.16 81.72
PBPC+PSA 0.80（0.74~0.85） 71.67 85.19 >0.35 64.23 89.06
PBPC+PSA+ISUP 0.81（0.76~0.86） 68.33 83.95 >0.36 61.26 87.71
PBPC+PSA+ISUP+PI-RADS评分 0.81（0.76~0.86） 76.67 75.93 >0.26 54.17 89.83
图2 PBPC在高危及非高危组中预测EPE的ROC曲线
图3 PSA在高危及非高危组中预测EPE的ROC曲线
[1]
Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention[J]. J Urol, 2017, 197(2S): S165-S170.
[2]
Mottet N, Bellmunt J, Bolla M, et al. Eau-estro-siog guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent[J]. Eur Urol, 2017, 71(4): 618-629.
[3]
Hassan O, Han M, Zhou A, et al. Incidence of extraprostatic extension at radical prostatectomy with pure gleason score 3+3= 6 (grade group 1) cancer: implications for whether gleason score 6 prostate cancer should be renamed "not cancer" and for selection criteria for active surveillance[J]. J Urol, 2018,199(6):1482-1487.
[4]
Cooperberg MR, Lubeck DP, Mehta SS, et al. Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE)[J]. J Urol, 2003, 170(6 Pt 2): 21-27.
[5]
Partin AW, Kattan MW, Subong EN, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update[J]. JAMA, 1997, 277(18): 1445-1451.
[6]
Miyamoto S, Goto K, Honda Y, et al. Tumor contact length of prostate cancer determined by a three-dimensional method on multiparametric magnetic resonance imaging predicts extraprostatic extension and biochemical recurrence[J]. Int J Urol, 2021, 28(10): 1012-1018.
[7]
Hou Y, Zhang YH, Bao J, et al. Artificial intelligence is a promising prospect for the detection of prostate cancer extracapsular extension with mpMRI: a two-center comparative study[J]. Eur J Nucl Med Mol Imaging, 2021, 48(12): 3805-3816.
[8]
Feng TS, Sharif-Afshar AR, Wu J, et al. Multiparametric MRI improves accuracy of clinical nomograms for predicting extracapsular extension of prostate cancer[J]. Urology, 2015, 86(2): 332-337.
[9]
Pereira-Azevedo N, Braga I, Verbeek J F, et al. Prospective evaluation on the effect of interobserver variability of digital rectal examination on the performance of the rotterdam prostate cancer risk calculator[J]. Int J Urol, 2017, 24(12): 826-832.
[10]
de Rooij M, Hamoen EH, Witjes JA, et al. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis[J]. Eur Urol, 2016,70(2):233-245.
[11]
Lee T, Hoogenes J, Wright I, et al. Utility of preoperative 3 Tesla pelvic phased-array multiparametric magnetic resonance imaging in prediction of extracapsular extension and seminal vesicle invasion of prostate cancer and its impact on surgical margin status: Experience at a canadian academic tertiary care centre[J]. Can Urol Assoc J, 2017,11(5):E174-E178.
[12]
Kozikowski M, Zagożdżon B, Gola M, et al. Prostate imaging reporting and data system in prostate cancer staging and planning for radical prostatectomy[J]. Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 262-270.
[13]
Yamashita S, Kohjimoto Y, Sato H, et al. Pi-rads v2 findings of mri and positive biopsy core percentage would predict pathological extraprostatic extension in patients who underwent robot assisted radical prostatectomy: a retrospective study[J]. Urol J, 2022, 19(6): 438-444
[14]
Valette TN, Antunes AA, Leite KM, et al. Probability of extraprostatic disease according to the percentage of positive biopsy cores in clinically localized prostate cancer[J]. Int Braz J Urol, 2015, 41(3): 449-454.
[15]
Yang DD, Muralidhar V, Mahal BA, et al. Impact of percent positive biopsy cores on cancer-specific mortality for patients with high-risk prostate cancer[J]. Urol Oncol, 2020, 38(9): 735-739.
[16]
Park JW, Koh DH, Jang WS, et al. Predictors of adverse pathologic features after radical prostatectomy in low-risk prostate cancer[J]. BMC Cancer, 2018, 18(1): 545.
[17]
Eissa A, Elsherbiny A, Zoeir A, et al. Reliability of the different versions of Partin tables in predicting extraprostatic extension of prostate cancer: a systematic review and meta-analysis[J]. Minerva Urol Nefrol, 2019, 71(5): 457-478.
[18]
Crippa A, Srougi M, Dall'Oglio MF, et al. A new nomogram to predict pathologic outcome following radical prostatectomy[J]. Int Braz J Urol, 2006, 32(2): 155-164.
[19]
Mortensen MM, Mortensen PS, Borre M. Percentage of tumour-positive biopsy cores: An independent predictor of extraprostatic disease[J]. Scand J Urol Nephrol, 2009, 43(2): 109-113.
[20]
Morlacco A, Sharma V, Viers BR, et al. The incremental role of magnetic resonance imaging for prostate cancer staging before radical prostatectomy[J]. Eur Urol, 2016, 71(5): 701-704.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[3] 方晔, 谢晓红, 罗辉. 品管圈在提高前列腺癌穿刺检出率中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 722-727.
[4] 黄应雄, 叶子, 蒋鹏, 詹红, 姚陈, 崔冀. 急性肠系膜静脉血栓形成致透壁性肠坏死的临床危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 413-421.
[5] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[6] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[7] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[8] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[9] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[10] 侯超, 潘美辰, 吴文明, 黄兴广, 李翔, 程凌雪, 朱玉轩, 李文波. 早期食管癌及上皮内瘤变内镜黏膜下剥离术后食管狭窄的危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 383-387.
[11] 张雯, 宋牡丹, 邓雪婷, 张云. 强化营养支持辅助奥曲肽治疗肝硬化合并食管胃底静脉曲张破裂出血的疗效及再出血危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 456-460.
[12] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1010-1015.
[13] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[14] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[15] 王苏贵, 皇立媛, 姜福金, 吴自余, 张先云, 李强, 严大理. 异质性细胞核核糖蛋白A2B1在前列腺癌中的作用及其靶向中药活性成分筛选研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 731-736.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号