Li Zhicun, Wu Tianyu, Liang Lei, Fan Yu, Meng Yisen, Zhang Qian
Department of Urology, Peking University First Hospital; Institution of Urology, Peking University; Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center; National Urological Cancer Center, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Oct 18;56(5):896-901. doi: 10.19723/j.issn.1671-167X.2024.05.022.
To analyze the risk factors for postoperative pathological upgrade of prostate cancer patients with single core positive biopsy, and to attempt to build a mathematical model for predicting postoperative pathological upgrade in these cancer patients with single core positive biopsy.
A retrospective analysis was conducted on 1 349 patients diagnosed with prostate cancer and undergoing radical prostatectomy at Peking University First Hospital from January 2015 to August 2020. The patients' age, body mass index, clinical stage, prostate imaging reporting and data system (PI-RADS) scores, prostate volume in magnetic resonance imaging (MRI), Gleason score of biopsy, serum prostate specific antigen (PSA) before biopsy and operation, surgical method and pathological stage were inclu-ded in the analysis. The variables with < 0.1 in univariate analysis were included to construct multi-variate Logistic regression and the nomogram was drawn. The model was evaluated using the receiver operating curve.
A total of 71 patients were included in this research, with 34 patients in the upgraded group and 37 patients in the non-upgraded group. There were no significant differences in the patients' age (=0.585), body mass index (=0.165), operation method (=0.08), prostate volume in MRI (=0.067), clinical stage (=0.678), PI-RADS score (=0.203), difference of PSA density (=0.063), Gleason score in biopsy (=0.068), PSA before puncture (=0.359) and operation (= 0.739) between the two groups. However, there were significant differences in the proportion of tumor tissue (=0.007), postoperative pathological stage ( < 0.001) and postoperative Gleason score ( < 0.001) between the two groups. The preoperative variables with a value of less than 0.1 (prostate volume in MRI, difference of PSA density, proportion of tumor tissue and Gleason score in biopsy) in univariate analysis were included in the Logistic regression, and the nomogram was drawn. Only the prostate volume in MRI had a value of less than 0.05. The area under the curve of the model was 0.773.
In patients with single core positive biopsy, if the prostate volume is small or the proportion of tumor in positive core is small, clinicians should be alert to the possibility of postoperative pathology upgrading, preoperative risk stratification should be carefully considered for patients with possible pathological upgrading. This model can be used to predict the pathological upgrade of patients with single core positive biopsy.
分析单灶阳性活检前列腺癌患者术后病理升级的危险因素，并尝试构建预测此类单灶阳性活检前列腺癌患者术后病理升级的数学模型。
回顾性分析2015年1月至2020年8月在北京大学第一医院诊断为前列腺癌并接受根治性前列腺切除术的1349例患者。分析患者的年龄、体重指数、临床分期、前列腺影像报告和数据系统（PI-RADS）评分、磁共振成像（MRI）中的前列腺体积、活检的Gleason评分、活检前及手术前的血清前列腺特异性抗原（PSA）、手术方式和病理分期。将单因素分析中P<0.1的变量纳入构建多因素Logistic回归并绘制列线图。采用受试者工作特征曲线对模型进行评估。
本研究共纳入71例患者，升级组34例，未升级组37例。两组患者的年龄（P=0.585）、体重指数（P=0.165）、手术方式（P=0.08）、MRI中的前列腺体积（P=0.067）、临床分期（P=0.678）、PI-RADS评分（P=0.203）、PSA密度差值（P=0.063）、活检的Gleason评分（P=0.068）、穿刺前PSA（P=0.359）及手术前PSA（P=0.739）比较，差异均无统计学意义。然而，两组患者的肿瘤组织比例（P=0.007）、术后病理分期（P<0.001）及术后Gleason评分（P<0.001）比较，差异均有统计学意义。将单因素分析中P值小于0.1的术前变量（MRI中的前列腺体积、PSA密度差值、肿瘤组织比例及活检的Gleason评分）纳入Logistic回归并绘制列线图。仅MRI中的前列腺体积P值小于0.05。模型的曲线下面积为0.773。
对于单灶阳性活检的患者，若前列腺体积较小或阳性灶中肿瘤比例较小，临床医生应警惕术后病理升级的可能性，对于可能发生病理升级的患者应仔细考虑术前风险分层。该模型可用于预测单灶阳性活检患者的病理升级。
