Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Cancer Epidemiol Biomarkers Prev. 2019 Aug;28(8):1331-1338. doi: 10.1158/1055-9965.EPI-19-0145. Epub 2019 Jun 3.
To evaluate the association of liver fibrosis scores with PSA level among U.S. adult men overall and by race/ethnicity.
Data from the National Health and Nutrition Examination Survey (NHANES), 2001-2010, were used. Males ages ≥40 years without a prostate cancer diagnosis and who had serum PSA, liver enzymes, albumin, and platelet counts measured as part of NHANES protocol were included. Liver fibrosis was measured using three scores: aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB-4), and NAFLD fibrosis score (NFS). We assessed overall and race/ethnicity-stratified geometric mean PSA by fibrosis score using predictive margins by linear regression, and the association of abnormal fibrosis scores (APRI > 1, FIB-4 > 2.67, NFS > 0.676) and elevated PSA (>4 ng/mL) by logistic regression.
A total of 6,705 men were included. Abnormal liver fibrosis scores were present in 2.1% (APRI), 3.6% (FIB-4), and 5.6% (NFS). Men with higher fibrosis scores had lower geometric mean PSA (all < 0.02). Men with abnormal APRI had a lower odds of PSA > 4 ng/mL [adjusted OR (aOR) = 0.33; 95% confidence interval (CI), 0.11-0.96]. Compared with men with 0 abnormal scores, those with 2 or 3 abnormal fibrosis scores had a lower odds of PSA > 4 ng/mL (aOR = 0.55; 95% CI, 0.33-0.91). The patterns were similar by race/ethnicity.
Men of all race/ethnicities with higher liver fibrosis scores had lower serum PSA, and men with advanced fibrosis scores had a lower odds of an elevated PSA.
These findings support further research to inform the likelihood of delay in prostate cancer detection in men with abnormal liver function.
评估美国成年男性的肝脏纤维化评分与 PSA 水平之间的关联，以及按种族/族裔划分的关联。
使用了 2001-2010 年国家健康和营养检查调查（NHANES）的数据。纳入年龄≥40 岁、无前列腺癌诊断且血清 PSA、肝酶、白蛋白和血小板计数作为 NHANES 方案一部分进行测量的男性。使用三种评分方法测量肝脏纤维化：天冬氨酸氨基转移酶与血小板比值指数（APRI）、纤维化 4 指数（FIB-4）和非酒精性脂肪性肝病纤维化评分（NFS）。我们使用线性回归的预测边缘评估了总体和按种族/族裔分层的纤维化评分的 PSA 几何均数，并使用逻辑回归评估了异常纤维化评分（APRI>1、FIB-4>2.67、NFS>0.676）和 PSA 升高（>4ng/ml）的相关性。
共纳入 6705 名男性。异常肝脏纤维化评分的发生率分别为 2.1%（APRI）、3.6%（FIB-4）和 5.6%（NFS）。纤维化评分较高的男性 PSA 几何均数较低（均<0.02）。异常 APRI 男性 PSA>4ng/ml 的可能性较低[调整后的比值比（aOR）=0.33；95%置信区间（CI），0.11-0.96]。与 0 个异常评分的男性相比，2 个或 3 个异常纤维化评分的男性 PSA>4ng/ml 的可能性较低（aOR=0.55；95%CI，0.33-0.91）。这些模式按种族/族裔相似。
所有种族/族裔的男性，纤维化评分越高，血清 PSA 越低，纤维化评分越高的男性 PSA 升高的可能性越低。
这些发现支持进一步研究，以告知肝脏功能异常男性前列腺癌检测延迟的可能性。
