种族对巴西志愿者前列腺癌患病率的影响。

Racial influence on the prevalence of prostate carcinoma in Brazilian volunteers.

作者信息

Paschoalin Edson L, Martins Antonio C P, Pastorello Mônica, Sândis Kiyoko A, Maciel Lea M Z, Silva Wilson A, Zago Marcos A, Bessa José

机构信息

Ribeirão Preto General Hospital, School of Medicine, USP, São Paulo, Brazil.

出版信息

Int Braz J Urol. 2003 Jul-Aug;29(4):300-5. doi: 10.1590/s1677-55382003000400003.

DOI:10.1590/s1677-55382003000400003

PMID:15745552

Abstract

PURPOSE

To investigate the prevalence of prostate carcinoma in a sample of volunteers known to have a large proportion of Bantu African ancestors, and the performance of total PSA (tPSA), PSA density (PSAD) and free-to-total PSA ratio (f/tPSA) on the diagnosis.

MATERIALS AND METHODS

A total of 473 volunteers (range: 40 - 79 years) were screened for prostate carcinoma. Those with tPSA >2 ng/ml and/or abnormal digital rectal examination were submitted to a transrectal ultrasound-directed biopsy (10 cores). The volunteers were classified as White, Mulatto or Black according to physical characteristics and to ancestors race reference. The following variable number of tandem repeats (VNTR) were analyzed in the blood of 120 volunteers without cancer and in 27 patients with prostate cancer: D4S43, PAH, F13A1, APOB and vW-1.

RESULTS

The biopsies performed in 121 volunteers revealed cancer in 27 (5.7% of 473). The proportions of cancer in White, Mulatto and Black were respectively: 0.6% (1/148), 6.7% (6/90) and 8.5% (20/235) (p = 0.006). The VNTRs analysis revealed heterogeneity in White, Mulatto and Black anthropologic phenotypes with the following admixture of Caucasian, African and Amerindian gene lineages: 67.5 +/- 8%, 20.8 +/- 8%, 11.7 +/- 7%; 54.8 +/- 9%, 36.3 +/- 5%, 8.9 +/- 7%; and, 45.3 +/- 3%, 45.9 +/- 4%, 8.8 +/-7%. Such a mixture was 50.5 +/- 9%, 49 +/- 8% and 0.5 +/- 4% in volunteers bearing cancer, and 59.1 +/- 7%, 31.7 +/- 8% and 9.2 +/- 5% in those without cancer. The sensitivity and specificity of tPSA at cut-off levels of 2, 2.5 and 4 ng/ml for volunteers with tPSA </= 10 ng/ml were respectively: 100% and 6,6%, 100% and 36,6%, 69,2% and 62,2%. PSAD at a cut-off level of 0.08 or 0.10, and f/tPSA at a cut-off level of 20% were able to increase significantly tPSA specificity without loss on sensitivity.

CONCLUSIONS

The tumor prevalence was higher in Non-White than in White phenotype. The association of tPSA at a cut-off level of 2.5 ng/ml with a PSAD of 0.08 or a f/tPSA of 20% for biopsy indication deserves further investigations as an alternative to tPSA cut-off level of 4 ng/ml.

摘要

目的

调查在已知有很大比例班图非洲裔祖先的志愿者样本中前列腺癌的患病率，以及总前列腺特异性抗原（tPSA）、前列腺特异性抗原密度（PSAD）和游离前列腺特异性抗原与总前列腺特异性抗原比值（f/tPSA）在诊断中的表现。

材料与方法

共对473名志愿者（年龄范围：40 - 79岁）进行前列腺癌筛查。tPSA>2 ng/ml和/或直肠指检异常者接受经直肠超声引导下活检（10针）。根据身体特征和祖先种族参考，将志愿者分为白人、混血儿或黑人。在120名无癌志愿者和27名前列腺癌患者的血液中分析了以下可变数目串联重复序列（VNTR）：D4S43、PAH、F13A1、APOB和vW-1。

结果

对121名志愿者进行的活检显示27人患有癌症（占473人的5.7%）。白人、混血儿和黑人中的癌症比例分别为：0.6%（1/148）、6.7%（6/90）和8.5%（20/235）（p = 0.006）。VNTR分析显示白人、混血儿和黑人人类学表型存在异质性，具有以下高加索、非洲和美洲印第安基因谱系的混合比例：67.5±8%、20.8±八%、11.7±7%；54.8±9%、36.3±5%、8.9±7%；以及45.3±3%、45.9±4%、8.8±7%。在患癌志愿者中，这种混合比例为50.5±9%、49±8%和0.5±4%，在无癌志愿者中为59.1±7%、31.7±8%和9.2±5%。对于tPSA≤10 ng/ml的志愿者，tPSA在2、2.5和4 ng/ml临界值水平时的敏感性和特异性分别为：100%和6.6%、100%和36.6%、69.2%和62.2%。PSAD在临界值水平为0.08或0.10时，以及f/tPSA在临界值水平为20%时，能够显著提高tPSA的特异性而不损失敏感性。