Chong Ari, Hwang Insang, Ha Jung-Min, Yu Seong Hyeon, Hwang Eu Chang, Yu Ho Song, Kim Sun Ouck, Jung Seung-Il, Kang Taek Won, Kwon Dong Deuk, Park Kwangsung
Department of Nuclear Medicine, Chosun University Hospital, Republic of Korea;
Department of Urology, Chonnam National University Hospital, Republic of Korea.
Can Urol Assoc J. 2014 Jul;8(7-8):E515-9. doi: 10.5489/cuaj.2054.
We evaluated the accuracy of current guidelines by analyzing bone scan results and clinical parameters of patients with prostate cancer to determine the optimal guideline for predicting bone metastasis.
We retrospectively analyzed patients who were diagnosed with prostate cancer and who underwent a bone scan. Bone metastasis was confirmed by bone scan results with clinical and radiological follow-up. Serum prostate-specific antigen, Gleason score, percent of positive biopsy core, clinical staging and bone scan results were analyzed. We analyzed diagnostic performance in predicting bone metastasis of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA), and the National Comprehensive Cancer Network (NCCN) guidelines as well as Briganti's classification and regression tree (CART). We also compared the percent of positive biopsy core between patients with and without bone metastases.
A total 167 of 806 patients had bone metastases. Receiver operating curve analysis revealed that the AUA and EAU guidelines were better for detecting bone metastases than were Briganti's CART and NCCN. No significant difference was observed between AUA and EAU guidelines. Patients with bone metastases had a higher percent positive core than did patients without metastasis (the cut-off value >55.6).
The EAU and AUA guidelines showed better results than did Briganti's CART and NCCN for predicting bone metastasis in the enrolled patients. A bone scan is strongly recommended for patients who have a higher percent positive core and who meet the EAU and AUA guidelines.
我们通过分析前列腺癌患者的骨扫描结果和临床参数来评估当前指南的准确性，以确定预测骨转移的最佳指南。
我们回顾性分析了被诊断为前列腺癌并接受骨扫描的患者。通过骨扫描结果以及临床和影像学随访来确认骨转移。分析血清前列腺特异性抗原、 Gleason评分、阳性活检核心的百分比、临床分期和骨扫描结果。我们分析了欧洲泌尿外科学会（EAU）、美国泌尿外科学会（AUA）和美国国立综合癌症网络（NCCN）指南以及布里甘蒂分类与回归树（CART）在预测骨转移方面的诊断性能。我们还比较了有和无骨转移患者之间阳性活检核心的百分比。
806例患者中共有167例发生骨转移。受试者工作特征曲线分析显示，AUA和EAU指南在检测骨转移方面比布里甘蒂的CART和NCCN更好。AUA和EAU指南之间未观察到显著差异。有骨转移的患者阳性核心百分比高于无转移患者（临界值>55.6）。
在本研究患者中，EAU和AUA指南在预测骨转移方面比布里甘蒂的CART和NCCN显示出更好的结果。对于阳性核心百分比高且符合EAU和AUA指南的患者，强烈建议进行骨扫描。
