Department of Surgery, Division of Urology, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA; Surgery Section, Durham VA Health Care System, Durham, NC, USA.
Cancer Epidemiol. 2019 Oct;62:101578. doi: 10.1016/j.canep.2019.101578. Epub 2019 Aug 1.
A previous pilot study found that men with a positive prostate biopsy had low numbers of circulating natural killer (NK) cells, compared to biopsy negative men.
To confirm these data, we analyzed differences in NK cells from 94 men undergoing prostate biopsy to determine whether NK cells could predict for a positive biopsy. NK cells activity (NKA) was measured by an in vitro diagnostic system, with a pre-defined cut-off value for NKA at 200 pg/mL. Logistic regression and receiver operator characteristics (Area Under the Curve (AUC)) analyses were used to test the diagnostic value of NKA.
The NKA test performance showed specificity of 88%, positive predictive value of 84%, sensitivity of 34%, and a negative predictive value of 41%. Among the 94 men analyzed, NKA was not significantly linked with age, race, digital rectal examination (DRE), prostate volume, PSA or biopsy grade group (all P ≥ 0.14). In multivariable logistic regression analysis, the odds ratio (OR) of low NKA (<200 pg/mL) for the detection of PC was 4.89, 95%CI 1.34-17.8, with a ROC area under the curve of 0.79 in all participants and increasing to 0.83 and 0.85 for the detection of PC and high-grade PC, respectively, among men with a normal DRE.
Men with a low NKA value had five-times higher odds of PC at biopsy. The implementation of this NKA assay in the clinic together with PSA may help to advise patients with the highest risk of PC whether, or not, to undergo a prostate biopsy.
先前的一项初步研究发现，与前列腺活检阴性的男性相比，前列腺活检阳性的男性循环自然杀伤（NK）细胞数量较低。
为了证实这些数据，我们分析了 94 名接受前列腺活检的男性的 NK 细胞差异，以确定 NK 细胞是否可以预测活检呈阳性。NK 细胞活性（NKA）通过体外诊断系统进行测量，NKA 的预定义截断值为 200pg/ml。使用逻辑回归和受试者工作特征（ROC 曲线下面积（AUC））分析来测试 NKA 的诊断价值。
NKA 测试性能显示特异性为 88%，阳性预测值为 84%，敏感性为 34%，阴性预测值为 41%。在分析的 94 名男性中，NKA 与年龄、种族、直肠指检（DRE）、前列腺体积、PSA 或活检分级组均无显著相关性（均 P≥0.14）。在多变量逻辑回归分析中，低 NKA（<200pg/ml）检测 PC 的优势比（OR）为 4.89，95%CI 为 1.34-17.8，所有参与者的 ROC 曲线下面积为 0.79，而在 DRE 正常的男性中，检测 PC 和高级别 PC 的 ROC 曲线下面积分别增加至 0.83 和 0.85。
NKA 值较低的男性在活检时患 PC 的几率高 5 倍。该 NKA 检测在临床上与 PSA 联合使用，可能有助于建议具有最高 PC 风险的患者是否进行前列腺活检。
