Performance of Serum Prostate-Specific Antigen Isoform [-2]proPSA (p2PSA) and the Prostate Health Index (PHI) in a Chinese Hospital-Based Biopsy Population
Performance of Serum Prostate-Specific Antigen Isoform [-2]proPSA (p2PSA) and the Prostate Health Index (PHI) in a Chinese Hospital-Based Biopsy Population
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中国医院活检人群血清前列腺特异性抗原亚型 [-2]proPSA (p2PSA) 和前列腺健康指数 (PHI) 的表现
DOI：
10.1002/pros.22876
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发表时间：
2014-11-01
期刊：
影响因子：
2.8
通讯作者：
Xu, Jianfeng
中科院分区：
文献类型：
--
作者：
Na, Rong;Ye, Dingwei;Xu, Jianfeng
背景。在西方国家，使用血清 [-2]proPSA (p2PSA) 及其衍生物前列腺健康指数 (PHI) 来检测前列腺癌 (PCa) 已被一致证明在区分活检结果方面比总前列腺特异性抗原 (tPSA) 具有更好的性能。然而，人们对它们在中国男性身上的表现却知之甚少。我们的目标是测试 p2PSA 和 PHI 的性能以及它们在区分中国男性活检结果方面对 tPSA 的附加价值。连续招募2012-2013年期间在中国上海三家三级医院接受前列腺活检的患者。使用 Beckman Coulter 的 DxI 800 免疫测定系统集中测量血清 tPSA、游离 PSA (fPSA) 和 p2PSA。主要结局是 PCa，次要结局是高级别 PCa（格里森评分为 4 + 3 或更差）。使用受试者工作特征曲线下面积 (AUC)、检出率和决策曲线分析 (DCA) 来评估判别性能。 结果。在 636 名接受前列腺活检的患者中，PHI 是活检结果的重要预测因子，独立于其他临床变量。在整个队列中，区分 PCa 和非 PCa 的 AUC 始终高于 tPSA（0.88 比 0.81），以及 tPSA 为 2-10 ng/ml（0.73 比 0.53）、10.1-20 ng/ml（0.81 比 0.58）和 tPSA >20 ng/ml 的患者（0.90 与 0.80）。所有比较中差异均具有统计学显着性，P < 0.01。为了检测队列中 90% 的 PCa，需要分别根据 PHI 和 tPSA 截止值对 362 名和 457 名患者进行活检，PHI 减少 21%。在区分高级别 PCa 方面也发现了类似的结果。结论。在中国接受前列腺活检的患者中，PHI 在区分 PCa 和高级别 PCa 方面比 tPSA 更具附加值。 (C) 2014 年 Wiley 期刊公司。
BACKGROUND. The use of serum [-2]proPSA (p2PSA) and its derivative, the prostate health index (PHI), in detecting prostate cancer (PCa) have been consistently shown to have better performance than total prostate-specific antigen (tPSA) in discriminating biopsy outcomes in western countries. However, little is known about their performance in Chinese men. Our objective is to test the performance of p2PSA and PHI and their added value to tPSA in discriminating biopsy outcomes in Chinese men.METHODS. Consecutive patients who underwent prostate biopsy in three tertiary hospitals in Shanghai, China during 2012-2013 were recruited. Serum tPSA, free PSA (fPSA), and p2PSA were measured centrally using Beckman Coulter's DxI 800 Immunoassay System. The primary outcome is PCa and the secondary outcome is high-grade PCa (Gleason Score of 4 + 3 or worse). Discriminative performance was assessed using the area under the receiver operating characteristic curve (AUC), detection rate and Decision Curve Analysis (DCA).RESULTS. Among 636 patients who underwent prostate biopsy, PHI was a significant predictor of biopsy outcomes, independent of other clinical variables. The AUC in discriminating PCa from non-PCa was consistently higher for PHI than tPSA in the entire cohort (0.88 vs. 0.81) as well as in patients with tPSA at 2-10 ng/ml (0.73 vs. 0.53), at 10.1-20 ng/ml (0.81 vs. 0.58), and at tPSA >20 ng/ml (0.90 vs. 0.80). The differences were statistically significant in all comparisons, P < 0.01. To detect 90% of all PCa in the cohort, 362 and 457 patients would need to be biopsied based on PHI and tPSA cutoff, respectively, a 21% reduction for PHI. Similar results were found for discriminating high-grade PCa.CONCLUSIONS. PHI provides added value over tPSA in discriminating PCa and high-grade PCa in patients who underwent prostate biopsy in China. (C) 2014 Wiley Periodicals, Inc.