摘要
目的 ROC曲线分析探讨前列腺特异性抗原密度(PSAD)、总PSA(tPSA)和游离PSA/总PSA(fPSA/tPSA)3者在PSA灰区前列腺癌(PCa)中的临床诊断价值。方法回顾性分析tPSA在4～10ng/ml之间的前列腺增生(BPH)患者75例和前列腺癌患者31例。化学发光法测定血清tPSA和fPSA,经直肠超声(TRUS)测定前列腺体积,计算fPSA/tPSA和PSAD。比较BPH组和PCa组间tPSA、PSAD和fPSA/tPSA各指标的差异,分析各指标在ROC曲线下的面积、各指标的诊断特异性及敏感性。结果PCa组与BPH组tPSA差异无统计学意义(P>0.05),PCa组fPSA/tPSA比值较BPH组降低(P<0.01),PSAD值较BPH组升高(P<0.05)。ROC曲线下的面积从大到小为fPSA/tPSA>PSAD>tPSA。在诊断敏感性相同的情况下,fPSA/tPSA比值诊断特异性高于PSAD的诊断特异性。当fPSA/tPSA临界值取0.16时,诊断前列腺癌的灵敏度和特异性为67.7%和79.7%,PSAD临界值取0.12时,其灵敏度和特异性为61.3%和62.7%。结论当tPSA在诊断灰区时,PSAD和fPSA/tPSA可以提高前列腺癌的诊断特异性和敏感性,fPSA/tPSA较PSAD有更高的诊断价值。
Objective To evaluate the clinical diagnostic value of tPSA, fPSA/tPSA ratio and PSAD in diagnosis of prostate cancer by using ROC curve under tPSA in diagnostic gray zone. Methods Total of 106 patients （75 benign prostate hyperplasia patients and 31 prostate cancer patients） were retrospectively analyzed. The concentration of tPSA and fPSA were detected by chemiluminescence-assay and the volume of prostate was measured by transrectal ultrasound. Then fPSA / tPSA ratio and PSAD were computed by formula. The difference of PSAD, fPSA/tPSA ratio and tPSA between the PCa group and BPH group, the area under ROC curve, the sensitivity and the specificity were analyzed respectively. Results There was no difference in tPSA level between PCa group and BPH group （P〉0.05）, wherea PSAD level of PCa group was significantly higher than that of BPH group （P〈0.05）. The fPSA/tPSA ratio of PCa group was lower than that of BPH group （P〈0.01）. The area under ROC curve of three indexes in descending order was fPSA/tPSA radio, PSAD and tPSA. The specificity of fPSA/tPSA ratio （79.7%） were significantly higher than that of PSAD （50.7%） under same sensitivity.When the cutoff of fPSA/tPSA ratio and PSAD were 0. 16 and 0.12, the sensitivity and specificity of diagnosing PCa were 67.7% and 61.3%,79.7% and 62.7% respectively. Conclusion The PSAD, fPSA/tPSA ratio can improve diagnosis of prostate cancer under tPSA in gray zone and the fPSA/tPSA ratio was better than than PSAD in diagnosis of prostate cancer.
出处
《中国男科学杂志》
CAS
CSCD
2008年第10期33-35,共3页
Chinese Journal of Andrology
