摘要
目的分析老年前列腺癌根治术(RP)后患者生化复发的影响因素,探讨术前游离前列腺特异性抗原(fPSA)/总前列腺特异性抗原(tPSA)比值对老年RP后生化复发的评估价值。方法选择2019年6月至2022年6月期间于濮阳市安阳地区医院泌尿外科行前列腺癌根治术的88例老年患者作为研究对象,术后随访2年,根据是否生化复发将患者分为复发组(n=27)和未复发组(n=61),比较两组患者的临床资料,采用多因素Logistic回归分析老年RP患者术后生化复发的影响因素;术前采用电化学发光全自动免疫分析系统检测并比较两组患者的fPSA、tPSA,计算fPSA/tPSA比值。采用受试者工作特性(ROC)曲线分析术前fPSA/tPSA比值对老年RP患者术后生化复发的评估价值。结果复发组患者TNM分期T3~T4期比例、Gleason评分≥8分比例、手术切缘阳性比例明显高于未复发组,差异均有统计学意义(P<0.05);多因素Logistic分析结果显示,Gleason评分≥8分、手术切缘阳性、fPSA≥7.09 ng/mL、tPSA≥40.54 ng/mL、fPSA/tPSA比值≤0.17均是老年RP患者术后生化复发的危险因素(P<0.05)。复发组患者的fPSA、tPSA分别为(8.02±2.31)ng/mL、(48.95±14.98)ng/mL,明显高于未复发组的(6.15±1.38)ng/mL、(32.13±8.34)ng/mL,fPSA/tPSA比值为0.16±0.01,明显低于未复发组的0.19±0.02,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,fPSA/tPSA比值评估老年RP患者术后生化复发的AUC为0.918,高于术前fPSA、tPSA单独评估的0.742、0.825(Z=10.438、9.816,P<0.001)。结论Gleason评分≥8分、手术切缘阳性及术前fPSA/tPSA比值降低是影响老年前列腺癌患者根治术后生化复发的重要因素,术前fPSA/tPSA比值对术后生化复发具有较高的预测价值,可作为辅助评估指标。
Objective To analyze the factors influencing biochemical recurrence in elderly patients after radical prostatectomy(RP)and to explore the evaluation value of the preoperative free prostate-specific antigen(fPSA)to total prostate-specific antigen(tPSA)ratio for biochemical recurrence after RP in the elderly.Methods Eighty-eight elderly patients who underwent RP in the Department of Urology,Anyang District Hospital,Puyang City from June 2019 to June 2022 were selected as the study subjects.They were followed up for 2 years postoperatively.Based on the occurrence of biochemical recurrence,patients were divided into a recurrence group(n=27)and a non-recurrence group(n=61).Clinical data were compared between the two groups.Multivariate logistic regression was used to analyze the factors influencing postoperative biochemical recurrence in elderly RP patients.Preoperative fPSA and tPSA levels were measured using an automated electrochemiluminescence immunoassay system and compared between the two groups,and the fPSA/tPSA ratio was calculated.The receiver operating characteristic(ROC)curve was used to analyze the evaluation value of the preoperative fPSA/tPSA ratio for postoperative biochemical recurrence in elderly RP patients.Results The proportions of TNM stage T3-T4,Gleason score≥8,and positive surgical margins in the recurrence group were significantly higher than those in the non-recurrence group(P<0.05).Multivariate logistic analysis showed that Gleason score≥8,positive surgical margins,fPSA≥7.09 ng/mL,tPSA≥40.54 ng/mL,and fPSA/tPSA ratio≤0.17 were all risk factors for postoperative biochemical recurrence in elderly RP patients(P<0.05).The fPSA and tPSA levels in the recurrence group were(8.02±2.31)ng/mL and(48.95±14.98)ng/mL,respectively,significantly higher than(6.15±1.38)ng/mL and(32.13±8.34)ng/mL in the non-recurrence group.The fPSA/tPSA ratio in the recurrence group was 0.16±0.01,significantly lower than 0.19±0.02 in the non-recurrence group(P<0.05).ROC curve analysis showed that the AUC of the fPSA/tPSA ratio for evaluating postoperative biochemical recurrence in elderly RP patients was 0.918,which was significantly higher than the AUCs of preoperative fPSA(0.742)and tPSA(0.825)alone(Z=10.438,9.816,P<0.001).Conclusion Gleason score≥8,positive surgical margins,and a decreased preoperative fPSA/tPSA ratio are important factors affecting biochemical recurrence in elderly prostate cancer patients after radical prostatectomy.The preoperative fPSA/tPSA ratio has high predictive value for postoperative biochemical recurrence and can serve as an auxiliary evaluation indicator.
作者
刘斌
翟国炜
张宏伟
LIU Bin;ZHAI Guo-wei;ZHANG Hong-wei(Department of Urology,Anyang Regional Hospital,Puyang City,Anyang 455000,Henan,CHINA)
出处
《海南医学》
2025年第24期3497-3501,共5页
Hainan Medical Journal
基金
二〇二四年度河南省医学科技攻关计划项目(编号:LHGJ20240803)。
