前列腺健康指数和%p2PSA预测接受根治性前列腺切除术的中国患者的侵袭性前列腺癌病理情况。

Prostate Health Index and %p2PSA Predict Aggressive Prostate Cancer Pathology in Chinese Patients Undergoing Radical Prostatectomy.

作者信息

Chiu Peter Ka-Fung, Lai Fernand Mac-Moune, Teoh Jeremy Yuen-Chun, Lee Wai-Man, Yee Chi-Hang, Chan Eddie Shu-Yin, Hou See-Ming, Ng Chi-Fai

机构信息

Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.

Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.

出版信息

Ann Surg Oncol. 2016 Aug;23(8):2707-14. doi: 10.1245/s10434-016-5183-6. Epub 2016 Mar 10.

DOI:10.1245/s10434-016-5183-6

PMID:26965697

Abstract

PURPOSE

To investigate the performance of prostate health index (PHI) and percentage prostate-specific antigen (PSA) isoform [-2]proPSA (%p2PSA) in predicting pathologic outcomes at radical prostatectomy (RP) in a Chinese population.

METHODS

We performed a prospective study of 135 prostate cancer patients with RP. The accuracy of preoperative %p2PSA (= p2PSA/free PSA) and PHI [= (p2PSA/free PSA) × √PSA] in predicting pathologic outcomes of RP including pT3 disease, pathologic Gleason score (pGS) ≥7, Gleason score (GS) upgrade at RP, tumor volume >0.5 ml, and Epstein criteria for significant tumor were calculated using multivariate analyses and area under the curve. The base model in multivariate analysis included age, PSA, abnormal digital rectal examination, and biopsy GS.

RESULTS

PHI was significantly higher in patients with pT3 or pGS ≥ 7 (p < 0.001), pT3 disease (p = 0.001), pGS ≥ 7 (p < 0.001), GS upgrade (p < 0.001), tumor volume >0.5 ml (p < 0.001), and Epstein criteria for significant tumor (p = 0.001). %p2PSA was also significantly higher in all the above outcomes. The risk of pT3 or pGS ≥ 7 was 16.1 % for PHI < 35 and 60.8 % for PHI > 35 (sensitivity 84.2 %, specificity of 60.3 %), and the risk of tumor volume >0.5 ml was 25.5 % for PHI < 35 and 72.6 % for PHI > 35 (sensitivity 79.1 %, specificity 67.2 %). In multivariate analysis, adding %p2PSA or PHI to the base model significantly improved the accuracy (area under the curve) in predicting pT3 or pGS ≥ 7 (by 7.2-7.9 %), tumor volume >0.5 ml (by 10.3-12.8 %), and Epstein criteria for significant tumor (by 13.9-15.9 %). Net clinical benefit was observed in decision curve analyses for prediction of both tumor volume >0.5 ml, and pT3 or pGS ≥ 7.

CONCLUSIONS

Both PHI and %p2PSA predict aggressive and significant pathologies in RP in Chinese men. This enabled identification of nonaggressive cancers for better counseling on active surveillance or treatment.

摘要

目的

探讨前列腺健康指数（PHI）和前列腺特异性抗原（PSA）同工型[-2]proPSA百分比（%p2PSA）在中国人群中预测根治性前列腺切除术（RP）病理结果的性能。

方法

我们对135例行RP的前列腺癌患者进行了一项前瞻性研究。采用多因素分析和曲线下面积计算术前%p2PSA（=p2PSA/游离PSA）和PHI[=（p2PSA/游离PSA）×√PSA]预测RP病理结果的准确性，这些结果包括pT3期疾病、病理Gleason评分（pGS）≥7、RP时Gleason评分（GS）升级、肿瘤体积>0.5ml以及符合Epstein标准的显著肿瘤。多因素分析中的基础模型包括年龄、PSA、直肠指检异常和活检GS。

结果

pT3或pGS≥7、pT3期疾病、pGS≥7、GS升级、肿瘤体积>0.5ml以及符合Epstein标准的显著肿瘤患者的PHI显著更高（p<0.001、p=0.001、p<0.001、p<0.001、p<0.001、p=0.001）。上述所有结果中%p2PSA也显著更高。PHI<35时pT3或pGS≥7的风险为16.1%，PHI>35时为60.8%（敏感性84.2%，特异性60.3%），PHI<35时肿瘤体积>0.5ml的风险为25.5%，PHI>35时为72.6%（敏感性79.1%，特异性67.2%）。在多因素分析中，在基础模型中加入%p2PSA或PHI显著提高了预测pT3或pGS≥7（提高7.2 - 7.9%）、肿瘤体积>0.5ml（提高10.3 - 12.8%）以及符合Epstein标准的显著肿瘤（提高13.9 - 15.9%）的准确性（曲线下面积）。在预测肿瘤体积>0.5ml以及pT3或pGS≥7的决策曲线分析中观察到净临床获益。