前列腺健康指数在预测韩国男性前列腺癌的存在和侵袭性方面的作用：一项前瞻性观察研究。
Usefulness of the prostate health index in predicting the presence and aggressiveness of prostate cancer among Korean men: a prospective observational study.
机构信息
Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
出版信息
BMC Urol. 2021 Sep 16;21(1):131. doi: 10.1186/s12894-021-00897-2.
BACKGROUND
We aimed to evaluate the usefulness of the Beckman Coulter prostate health index (PHI) and to compare it with total prostate-specific antigen (PSA) levels and related derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in the Korean population.
METHODS
A total of 140 men who underwent their first prostate biopsy for suspected PCa were included in this prospective observational study. The diagnostic performance of total PSA, free PSA, %free PSA, [-2] proPSA (p2PSA), %p2PSA, and PHI in detecting and predicting the aggressiveness of PCa was estimated using the receiver operating characteristic curve (ROC) and logistic multivariate regression analyses.
RESULTS
Of 140 patients, PCa was detected in 63 (45%) of participants, and 48 (76.2%) of them had significant cancer with a Gleason score (GS) ≥ 7. In the whole group, the area under the curve (AUC) for ROC analysis of tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.63, 0.57, 0.69, 0.69, 0.72, and 0.76, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p = 0.005). For PCa with GS ≥ 7, the AUCs for tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.62, 0.58, 0.41, 0.79, 0.86, and 0.87, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p < 0.001). In the subgroup with tPSA 4-10 ng/mL, both %p2PSA and PHI were strong independent predictors for PCa (p = 0.007, p = 0.006) and significantly improved the predictive accuracy of a base multivariable model, including age, tPSA, fPSA and %fPSA, using multivariate logistic regression analysis. (p = 0.054, p = 0.048). Additionally, at a cutoff PHI value > 33.4, 22.9% (32/140) of biopsies could be avoided without missing any cases of aggressive cancer.
CONCLUSIONS
This study shows that %p2PSA and PHI are superior to total PSA and %fPSA in predicting the presence and aggressiveness (GS ≥ 7) of PCa among Korean men. Using PHI, a significant proportion of unnecessary biopsies can be avoided.
背景
本研究旨在评估贝克曼库尔特前列腺健康指数（PHI）的实用性，并将其与总前列腺特异性抗原（PSA）水平及其相关衍生物进行比较，以预测韩国人群前列腺癌（PCa）的存在和侵袭性。
方法
本前瞻性观察性研究共纳入 140 名因疑似 PCa 而首次接受前列腺活检的男性。使用受试者工作特征曲线（ROC）和多变量逻辑回归分析，评估总 PSA、游离 PSA、%游离 PSA、[-2]前列腺特异性抗原（p2PSA）、%p2PSA 和 PHI 对检测和预测 PCa 侵袭性的诊断性能。
结果
在 140 名患者中，63 名（45%）患者检测出 PCa，其中 48 名（76.2%）患者具有显著的癌症，Gleason 评分（GS）≥7。在整个研究组中，tPSA、游离 PSA、%游离 PSA、p2PSA、%p2PSA 和 PHI 的 ROC 分析曲线下面积（AUC）分别为 0.63、0.57、0.69、0.69、0.72 和 0.76，PHI 组的 AUC 明显大于 tPSA 组（p=0.005）。对于 GS≥7 的 PCa，tPSA、游离 PSA、%游离 PSA、p2PSA、%p2PSA 和 PHI 的 AUC 分别为 0.62、0.58、0.41、0.79、0.86 和 0.87，PHI 组的 AUC 明显大于 tPSA 组（p<0.001）。在 tPSA 4-10ng/mL 的亚组中，%p2PSA 和 PHI 都是 PCa 的强独立预测因子（p=0.007，p=0.006），并且使用多变量逻辑回归分析显著提高了包括年龄、tPSA、fPSA 和 %fPSA 在内的基本多变量模型的预测准确性（p=0.054，p=0.048）。此外，在 PHI 截断值>33.4 时，22.9%（32/140）的活检可以避免，而不会遗漏任何侵袭性癌症病例。
结论
本研究表明，%p2PSA 和 PHI 优于总 PSA 和 %fPSA，可预测韩国男性 PCa 的存在和侵袭性（GS≥7）。使用 PHI 可以避免大量不必要的活检。
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