摘要
目的探讨前列腺特异性抗原（PSA）新参数：PSA质量（PSA mass,PSAM）和PSA质量比（PSA mass ratio,PSAMR）,在前列腺癌诊断中的应用价值。方法 2005年7月至2014年8月,我院病理科获得1 268例前列腺相关的病理结果,其中前列腺增生患者706例,前列腺癌患者562例,回顾性分析其临床资料。评价PSAM与PSAMR对前列腺癌的诊断价值,并与血清总PSA浓度（tPSA）、游离PSA百分比（f/tPSA）和PSA密度（PSAD）相比较。利用受试者工作特征曲线（ROC）确定其截点及相应的灵敏度和特异度。结果在全部患者中,PSA、f/tPSA、PSAD、PSAM和PSAMR在前列腺癌和前列腺增生患者间均存在明显差异（P〈0.05）;PSAM的ROC曲线下面积（AUC）为0.732,与tPSA（0.73）无明显差异（P〉0.05）,PSAMR的AUC为0.821,显著高于tPSA（P〈0.05）。当tPSA水平在4~10ng/mL时,PSAMR的AUC为0.856,显著高于f/tPSA（0.756）（P〈0.05）,与PSAD（0.85）相似（P〉0.05）。取ROC曲线上约登指数最大值时的切点为临界值,在总体患者中PSAMR取值0.595时,其诊断前列腺癌的灵敏度为69.6%,特异度为83.4%。当tPSA在4~10ng/mL范围时,PSAMR取值0.38,诊断灵敏度为77.2%,特异度为79.4%。结论 PSAM与PSAMR均可用于诊断前列腺癌,PSAM与PSA诊断能力相近,而PSAMR诊断能力高于PSA;在tPSA4~10ng/mL范围内,PSAMR诊断前列腺癌的能力高于f/tPSA。
Objective To explore the clinical value of prostate specific antigen new parameters：PSA mass（PSAM）and PSA mass ratio（PSAMR）for predicting prostate cancer.Methods We reviewed the clinical data of 1,268 patients with prostate related pathologic results,with 706 benign prostatic hyperplasia and 562 prostate cancer.To evaluate the diagnostic value of PSAM and PSAMR for predicting prostate cancer,and compare the predictive value of PSAM,PSAMR,total PSA（tPSA）,percent free PSA（f/tPSA）,and PSA density with receiver operating characteristic（ROC）curve.The cut-off value and related sensitivity and specificity of these parameters were determined by ROC curve.Results In all patients,PSA,f/tPSA,PSAD,PSAM and PSAMR had significant difference between prostate cancer and benign prostatic hyperplasia（P〈0.05）.The area under the ROC curve（AUC）of PSAM was 0.732,with no significant difference between tPSA（0.73）and PSAM（P〈0.05）.The AUC of PSAMR was 0.821,which was greater than tPSA（P〈0.05）.In patients with PSA4~10 ng/mL,the AUC of PSAMR was greater AUC than f/tPSA（0.856 vs.0.756）（P〈0.05）,but there was no significant difference between PSAMR and PSAD（0.856 vs.0.85）（P〈0.05）.The sensitivity and specificity of PSAMR were 77.2% and79.4%,respectively,with a cut-off value 0.595 determined by Youden Index in all patients.And in patients with PSA4~10 ng/mL,the sensitivity and specificity of PSAMR were 77.2% and 79.4%,with a cut-off value 0.38.Conclusion PSAM and PSAMR can be applied for predicting prostate cancer.PSAM has similar effectiveness with PSA,but the diagnostic value of PSAMR is greater than PSA.In patients with PSA4~10 ng/mL,PSAMR has better performance than f/tPSA in predicting prostate cancer.
出处
《现代泌尿外科杂志》
CAS
2015年第12期871-874,共4页
Journal of Modern Urology
关键词
前列腺
前列腺肿瘤
诊断
前列腺特异性抗原
prostate
prostatic neoplasms
diagnosis
prostate specific antigen
