前列腺健康指数在骨扫描前预测前列腺癌骨转移中的评估。
Evaluation of prostate health index in predicting bone metastasis of prostate cancer before bone scanning.
机构信息
Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
Key Laboratory of Urinary Precision Diagnosis and Treatment, Universities of Shandong, Jinan, China.
出版信息
Int Urol Nephrol. 2022 Dec;54(12):3079-3086. doi: 10.1007/s11255-022-03340-z. Epub 2022 Aug 20.
PURPOSE
In patients undergoing bone scanning, the positive rate of bone metastasis (BM) of prostate cancer (PCa) is quite low. The main purpose of this study was to explore the application of %p2PSA and prostate health index (phi) in predicting BM of PCa before bone scanning to reduce unnecessary bone scanning.
METHODS
A total of 279 PCa patients were enrolled in our study. The area under the ROC curve was used to evaluate the prediction accuracy of the variables. Binary logistic regression analysis was performed to establish a prediction model. A multivariate regression model was established to evaluate the predictive value of the variables. The nomogram model was established by R software. The patients were stratified into an intermediate-risk subgroup (T2b-T2c, Gleason score = 6-7) and a high-risk subgroup (cT3-4, Gleason score = 8-10). In the overall cohort and subgroups, McNemar's test was used for comparison of different predictive variables.
RESULTS
Of the 279 patients included in the study, 43 patients were identified as having BM by bone scanning. Univariate logistic regression analysis showed that age (p = 0.043), tPSA (p = 0.001), Ki-67 (p = 0.003), Gleason score (p = 0.001), clinical T stage (p < 0.001) and phi (p < 0.001) were significantly different in BM patients. In multivariate regression analysis, the model with phi showed significant diagnostic ability for predicting BM (AUC = 0.854). In the subgroup analysis, phi was significantly superior to tPSA in terms of the positive predictive value at sensitivities of 84.62% and 61.54% in the overall cohort (p < 0.001) and intermediate-risk subgroup (p < 0.001), respectively. Moreover, %p2PSA showed no significant advantage over tPSA (p > 0.05).
CONCLUSION
The level of phi was significantly related to the positive rate of BM in initially diagnosed PCa. In PCa patients with clinical stage T2b-T2c and Gleason score = 6-7, phi can be used as a surrogate indicator of tPSA for screening BM.
目的
在进行骨扫描的前列腺癌（PCa）患者中，骨转移（BM）的阳性率较低。本研究的主要目的是探讨在进行骨扫描之前，应用%p2PSA 和前列腺健康指数（phi）预测 PCa 的 BM，以减少不必要的骨扫描。
方法
共纳入 279 例 PCa 患者。采用 ROC 曲线下面积评估各变量的预测准确性。进行二元逻辑回归分析建立预测模型。建立多元回归模型以评估各变量的预测价值。使用 R 软件建立列线图模型。将患者分为中危亚组（T2b-T2c，Gleason 评分=6-7）和高危亚组（cT3-4，Gleason 评分=8-10）。在总队列和亚组中，采用 McNemar 检验比较不同预测变量。
结果
本研究共纳入 279 例患者，其中 43 例经骨扫描确诊为 BM。单因素逻辑回归分析显示，年龄（p=0.043）、tPSA（p=0.001）、Ki-67（p=0.003）、Gleason 评分（p=0.001）、临床 T 分期（p<0.001）和 phi（p<0.001）在 BM 患者中差异有统计学意义。多元回归分析显示，phi 模型对预测 BM 具有显著的诊断能力（AUC=0.854）。在亚组分析中，phi 在总体队列和中危亚组中，当灵敏度分别为 84.62%和 61.54%时，phi 在阳性预测值方面均明显优于 tPSA（p<0.001）。此外，%p2PSA 与 tPSA 相比无明显优势（p>0.05）。
结论
phi 水平与初诊 PCa 的 BM 阳性率显著相关。在临床分期 T2b-T2c、Gleason 评分=6-7 的 PCa 患者中，phi 可作为 tPSA 的替代指标用于筛查 BM。
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