Lee N, Newhouse J H, Olsson C A, Benson M C, Petrylak D P, Schiff P B, Bagiella E, Malyszko B, Ennis R D
Department of Radiation Oncology, School of Public Health, Columbia University, New York, New York, USA.
Urology. 1999 Sep;54(3):490-4. doi: 10.1016/s0090-4295(99)00150-8.
Although a computed tomography (CT) scan of the abdomen and pelvis is often recommended as part of the staging evaluation for newly diagnosed prostate cancer, most scans are negative for metastases. We hypothesized that biopsy Gleason score, serum prostate-specific antigen (PSA) levels, and clinical stage could predict for a positive CT scan and that a low-risk group of patients could be identified in whom CT might be omitted.
All patients who had both pathologic review of their prostate cancer biopsies and abdominopelvic CT scans at our institution between January 1990 and May 1996 were studied. Gleason score, PSA, and stage were evaluated by univariate (chi-square) and multivariate (logistic regression) analyses for their ability to predict for a positive CT.
Of 588 patients, 41 (7%) had a positive CT scan. Multivariate analysis showed Gleason score, PSA, and clinical stage to be significant independent predictors of a positive CT scan, all P <0.001. The odds ratios for a positive CT scan were 6.17 (95% confidence interval [CI] = 1.58 to 24) for Gleason score 8 to 10 versus 2 to 6; 2.25 (CI = 1.24 to 4) for PSA greater than 50 versus 0 to 15 ng/mL; 2.08 (CI = 1.70 to 3.21 ) for Stage T2c-T4 versus T2b or lower. All 244 patients with Gleason score 2 to 7, PSA 1 5 ng/mL or less, and clinical Stage T2b or less had negative CT scans. Of the other 174 patients with a Gleason score of 2 to 7, 8 (5%) had a positive CT scan. Of the 1 26 patients with a Gleason score of 8 to 10, 28 (22%) had a positive CT scan.
Gleason score, PSA, and clinical stage were independent predictors for a positive CT scan of the abdomen and pelvis in patients with newly diagnosed prostate cancer. In this cost-conscious era, we can decrease expenditure by obviating the need for a CT scan in low-risk patients (clinical Stage T2b or less, Gleason score 2 to 7, and PSA 15 ng/mL or less). A CT scan should be considered in all other patients.
虽然腹部和盆腔计算机断层扫描（CT）常被推荐作为新诊断前列腺癌分期评估的一部分，但大多数扫描结果显示无转移。我们推测活检Gleason评分、血清前列腺特异性抗原（PSA）水平和临床分期可预测CT扫描结果为阳性，并且可以识别出一组低风险患者，对其可省略CT检查。
对1990年1月至1996年5月间在我们机构同时接受前列腺癌活检病理检查和腹部盆腔CT扫描的所有患者进行研究。通过单因素（卡方检验）和多因素（逻辑回归）分析评估Gleason评分、PSA和分期预测CT扫描结果为阳性的能力。
588例患者中，41例（7%）CT扫描结果为阳性。多因素分析显示，Gleason评分、PSA和临床分期是CT扫描结果为阳性的显著独立预测因素，所有P<0.001。Gleason评分8至10分与2至6分相比，CT扫描结果为阳性的比值比为6.17（95%置信区间[CI]=1.58至24）；PSA大于50 ng/mL与0至15 ng/mL相比，比值比为2.25（CI=1.24至4）；T2c - T4期与T2b期或更低分期相比，比值比为2.08（CI=1.70至3.21）。所有Gleason评分为2至7分、PSA为15 ng/mL或更低且临床分期为T2b期或更低的244例患者CT扫描结果均为阴性。在其他174例Gleason评分为2至7分的患者中，8例（5%）CT扫描结果为阳性。在126例Gleason评分为8至10分的患者中，28例（22%）CT扫描结果为阳性。
Gleason评分、PSA和临床分期是新诊断前列腺癌患者腹部和盆腔CT扫描结果为阳性的独立预测因素。在这个注重成本的时代，我们可以通过无需对低风险患者（临床分期为T2b期或更低、Gleason评分为2至7分且PSA为15 ng/mL或更低）进行CT扫描来降低费用。所有其他患者均应考虑进行CT扫描。
