Scientific Reports:前列腺健康指数在预测根治性前列腺切除术标本Gleason评分升级和高危前列腺癌中的作用

2021-09-13 MedSci原创 MedSci原创

本研究为确定AS候选患者的适当治疗策略,及所有潜在PCa患者的治疗前咨询提供重要帮助,这将有助于对AS患者和考虑RP患者的管理。

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前列腺癌(PCa)治疗的一大挑战是发现那些未经主动监测(AS)进行管理的癌症。为了克服诊断时前列腺特异性抗原(tPSA)的局限性,[−2]proPSA (p2PSA)衍生物,如前列腺健康指数(PHI)、p2PSA百分比(%p2PSA)和PHI密度(PHID)也被推荐使用。目前,还没有检测PCCa和风险分层特异性的单个生物标志物。对于各种 PCa 筛查和管理方法,PHI 似乎是一种简单且廉价的测试。这项研究旨在评估PHI在局部PCA中的作用,以及它是否可以作为3 + 3 PCa根治性前列腺切除术(RP)标本的格里森评分(GS)升级的独立预测因素,以及RP标本中的不良病理特征。

在300例评估PHI并进行前列腺活检的患者中,92例(30.7%)诊断为csPCa。按 GS 升级分类的子组分析见下图。其中71名患者接受了RP,所有RP患者的GS升级率为33.8%(24/71)。手术前前列腺体积(p = 0.014)、活检时ISUP GG的分布(p = 0.001)和RP病理学的ISUP GG(p = 0.016)分布均显示显著差异。

24例RP患者的RP标本出现GS升级。多因素logistic回归分析显示,PHI值≥55(OR: 3.64[95%,[CI]= 1.05-12.68, p=0.042)和PI-RADS病变≥4 (OR: 7.03, 95% CI= 1.68-29.51, p=0.018)是RP标本中G升级高的重要预测因素(AUC=0.737)。

RP不良病理特征的预测因子(不良病理特征:≥pT3a或GS≥4+3)见下图。13例患者在RP中有不良的病理表现,PHI值≥55 (OR: 9.05, 5%CI= 1.04-78.52, p=0.046)是预测RP标本不良病理特征的重要因素(AUC=0.781)。

尽管已有大量关于PHI的报道,但PHI是否可以预测高危PCa的研究仍相对较少。最近PHI被用于为PSA水平处于灰色地带的患者,为PCa的确诊提供更多确定性。结果表明,PSAD 水平≥ 0.15 ng/ml/ml 也可以显著预测 RP 的不良病理特征(OR: 7.32,95% CI = 1.19+45.08,p = 0.032)。RP样本的GS升级检测是基础,因其可能会导致在初始活检时为低级别患者治疗不足的可能性降低。PHI 结果还可帮助临床医生在高 PHI 与 ISUP GG ≥ 3 中RP标本升级的患者,进行RP后辅助治疗。

综上,在ISUP GG 1+2中,PHI可以预测当合并PIRADS≥4病变时的GS升级。仅用PHI也可以评估术后出现不良病理特征的高危PCa的可能性。PHI或可改善csPCa的检测并提供预后信息。本研究为确定AS候选患者的适当治疗策略提供了机会,也可以为所有潜在PCa患者的治疗前咨询提供重要帮助,这将有助于对AS患者和考虑RP患者的管理。但PHI在PCa的几个方面的预测性还需要进一步的研究。

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  5. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Sat Sep 11 11:38:56 CST 2021, time=2021-09-11, status=1, ipAttribution=)]
    2022-03-25 huangdf
  6. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Sat Sep 11 11:38:56 CST 2021, time=2021-09-11, status=1, ipAttribution=)]
    2021-09-13 学医无涯

    学习一下~

    0

  7. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Sat Sep 11 11:38:56 CST 2021, time=2021-09-11, status=1, ipAttribution=)]
    2021-09-12 jichang
  8. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Sat Sep 11 11:38:56 CST 2021, time=2021-09-11, status=1, ipAttribution=)]
    2021-09-12 jeanqiuqiu
  9. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Sat Sep 11 11:38:56 CST 2021, time=2021-09-11, status=1, ipAttribution=)]
    2021-09-12 沐雨海马

    思路清晰,文笔流畅

    0

  10. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Sat Sep 11 11:38:56 CST 2021, time=2021-09-11, status=1, ipAttribution=)]
    2021-09-11 JZ Yang

    感谢分享

    0

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