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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (5): 896-901. doi: 10.19723/j.issn.1671-167X.2024.05.022

• 论著 • 上一篇    下一篇

穿刺活检单针阳性前列腺癌术后病理升级的危险因素分析及列线图模型构建

李志存, 吴天俣, 梁磊, 范宇, 孟一森*(), 张骞*()   

  1. 北京大学第一医院泌尿外科，北京大学泌尿外科研究所，泌尿生殖系疾病(男)分子诊治北京市重点实验室，国家泌尿男生殖系肿瘤中心，北京 100034
  • 收稿日期:2022-12-31 出版日期:2024-10-18 发布日期:2024-10-16
  • 通讯作者: 孟一森,张骞 E-mail:mgyss@qq.com; zhangqianbjmu@126.com;zhangqianbjmu@126.com
  • 作者简介:第一联系人：

    *These authors contributed equally to this work

  • 基金资助:
    国家重点研发计划(2022YFC3602902)

Risk factors analysis and nomogram model construction of postoperative pathological upgrade of prostate cancer patients with single core positive biopsy

Zhicun LI, Tianyu WU, Lei LIANG, Yu FAN, Yisen MENG*(), Qian ZHANG*()   

  1. 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
  • Received:2022-12-31 Online:2024-10-18 Published:2024-10-16
  • Contact: Yisen MENG, Qian ZHANG E-mail:mgyss@qq.com; zhangqianbjmu@126.com;zhangqianbjmu@126.com
  • Supported by:
    Supported by National Key Research and Development Program of China(2022YFC3602902)

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摘要：

目的: 对穿刺活检单针阳性前列腺癌术后病理升级的危险因素进行分析，并尝试构建预测穿刺单针阳性前列腺癌患者术后病理升级的数学模型。方法: 回顾分析2015年1月至2020年8月期间于北京大学第一医院诊断为前列腺癌且接受根治性前列腺切除术的患者1 349例，选取其中穿刺活检单针阳性患者的临床资料，将其分为术后病理较穿刺病理升级组及未升级组，比较两组的年龄、体重指数、临床分期、前列腺影像报告和数据系统(prostate imaging reporting and data system，PI-RADS)评分、磁共振成像(magnetic resonance imaging，MRI)报告的前列腺体积、前列腺穿刺活检的Gleason评分、穿刺前及术前血清前列腺特异性抗原(prostate specific antigen，PSA)、手术方式、术后病理分期的差异，将单因素分析中P < 0.1的术前变量纳入多因素Logistic回归并绘制列线图，通过受试者工作特征曲线对模型进行评价。结果: 共有71例患者符合纳入排除标准，其中术后病理升级组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前列腺体积(P=0.067)、临床分期(P=0.678)、PI-RADS评分(P=0.203)、穿刺前PSA(P=0.359)、术前PSA(P=0.739)、PSA密度差(P=0.063)、穿刺Gleason评分(P=0.068)差异均无统计学意义，两组患者穿刺阳性针中肿瘤组织占比(P=0.007)、术后病理分期(P < 0.001)及术后Gleason评分(P < 0.001)差异有统计学意义。将单因素分析中P < 0.1的术前变量，即MRI前列腺体积、PSA密度差、穿刺阳性针中的肿瘤组织占比、穿刺Gleason评分纳入多因素Logistic回归分析，只有MRI前列腺体积组间差异有统计学意义。进一步根据多因素Logistic回归结果绘制列线图，受试者工作特征曲线的曲线下面积为0.773。结论: 对于穿刺病理单针阳性的前列腺癌患者，若前列腺体积较小或穿刺阳性针中肿瘤组织占比较少，需警惕术后病理较穿刺病理升级的可能；对于可能出现病理升级的患者，需谨慎考虑术前的危险分层。本模型可初步用于预测穿刺活检单针阳性前列腺癌患者术后病理升级的可能性。

关键词: 前列腺肿瘤, 活组织检查, 针吸, 危险因素, 列线图, 单针阳性

Abstract:

Objective: 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. Methods: 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 P < 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. Results: 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 (P=0.585), body mass index (P=0.165), operation method (P=0.08), prostate volume in MRI (P=0.067), clinical stage (P=0.678), PI-RADS score (P=0.203), difference of PSA density (P=0.063), Gleason score in biopsy (P=0.068), PSA before puncture (P=0.359) and operation (P= 0.739) between the two groups. However, there were significant differences in the proportion of tumor tissue (P=0.007), postoperative pathological stage (P < 0.001) and postoperative Gleason score (P < 0.001) between the two groups. The preoperative variables with a P 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 P value of less than 0.05. The area under the curve of the model was 0.773. Conclusion: 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.

Key words: Prostatic neoplasms, Biopsy, needle, Risk factors, Nomograms, Single core positive

中图分类号: 

  • R737.25

表1

病理升级组及未升级组患者的临床病理资料与危险因素"

Items Non-upgrade group (n=37) Upgrade group (n=34) P
Age/years 65.38±5.95 66.21±6.73 0.585
BMI/(kg/m2) 24.47±2.83 25.40±2.74 0.165
Operation 0.080
  Laparoscopic 25 (67.6) 29 (85.3)
  Robotic 12 (32.4) 5 (14.7)
Prostate volume in MRI 0.067
  ≤30 mL 7 (18.9) 13 (38.2)
  ＞30 mL 30 (81.7) 21 (61.8)
cT stage 0.678
  1 13 (35.1) 9 (26.5)
  2 22 (59.5) 25 (73.5)
  3 2 (5.4) 0 (0)
PI-RADS 0.203
  ≤3 15 (40.5) 9 (26.5)
  ≥4 22 (59.5) 25 (73.5)
PSA/(ng/mL)
  Before biopsy 9.56±5.40 10.83±5.98 0.359
  Preoperative 9.62±5.12 10.04±5.31 0.739
Difference of PSA density 0.063
  ≤0 ng/mL2 16 (43.2) 22 (64.7)
  ＞0 ng/mL2 21 (56.8) 12 (35.3)
Proportion of tumor tissue 0.007
  ≤25% 20 (54.1) 28 (82.4)
  ＞25% 17 (45.9) 6 (17.6)
Gleason score in biopsy 0.068
  6 21 (56.8) 25 (73.5)
  3+4 6 (16.2) 6 (17.6)
  4+3 5 (13.5) 2 (5.9)
  ≥8 5 (13.5) 1 (3.0)
pT stage ＜0.001
  2 31 (83.8) 16 (47.1)
  3 6 (16.2) 18 (52.9)
Pathological Gleason score ＜0.001
  6 22 (59.5) 0 (0)
  3+4 8 (21.6) 18 (52.9)
  4+3 4 (10.8) 10 (29.5)
  ≥8 3 (8.1) 6 (17.6)

表2

术前穿刺单针阳性前列腺癌患者术后发生病理升级的影响因素的多因素Logistic回归分析结果"

Items OR 95%CI P
Gleason score in biopsy
  6 1
  3+4 0.725 0.160-3.329 0.134
  4+3 0.127 0.118-1.363 0.735
  ≥8 0.076 0.004-1.339 0.078
Prostate volume in MRI
  ≤30 mL 7.612 1.358-42.675 0.021
  ＞30 mL 1
Difference of PSA density
  ≤0 ng/mL2 1
  ＞0 ng/mL2 0.342 0.112-1.048 0.074
Proportion of tumor tissue
  ≤25% 1
  ＞25% 0.328 0.096-1.115 0.060

图1

预测单针穿刺阳性前列腺癌术后病理升级的列线图 GS, Gleason score; MRI, magnetic resonance imaging; PSA, prostate specific antigen."

图2

列线图模型的校准曲线"

图3

受试者工作特征曲线评估列线图模型"

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ISSN 1671-167X
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