Comparison of preoperative prostate specific antigen density and prostate specific antigen for predicting recurrence after radical prostatectomy: Results from the search data base
Comparison of preoperative prostate specific antigen density and prostate specific antigen for predicting recurrence after radical prostatectomy: Results from the search data base
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DOI：
10.1097/01.ju.0000051400.85694.bb
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发表时间：
2003-03-01
影响因子：
6.6
通讯作者：
Aronson, WJ
中科院分区：
文献类型：
--
作者：
Freedland, SJ;Kane, CJ;Aronson, WJ
目的：基于根治性前列腺切除术标本的手术重量的前列腺特异性抗原（PSA）密度先前已被证明是根治性前列腺切除术后生化复发的独立预测因子。我们确定使用经直肠超声前列腺体积计算的术前 PSA 密度是否比 PSA 更能预测晚期病理结果或根治性前列腺切除术后生化复发。 材料和方法：我们检查了新建立的共享平等访问区域癌症医院数据库中的 552 名男性，这些数据库在平等访问医疗中心接受根治性前列腺切除术治疗，以确定术前 PSA 密度是否是根治性前列腺切除术后不良病理状况或 PSA 复发的显着预测因子。将使用 PSA 密度的模型与使用 PSA 的模型进行比较，以确定 PSA 密度是否相对于 PSA 改善了风险分层。 PSA 密度作为连续变量和分类变量进行检查，使用截断值将患者分为不同 PSA 失败风险的组。结果：PSA 密度和 PSA 是单变量分析中不良病理结果的显着预测因子。相对于在模型中使用 PSA，在多变量模型中使用 PSA 密度在预测阳性手术切缘 (p = 0.134) 和囊外延伸 (p = 0.771) 方面略有改善，但在统计上无显着改善。 PSA 和 PSA 密度都不是精囊侵犯的显着独立预测因子。用于预测 PSA 和 PSA 密度生化复发的 ROC 曲线下面积没有显着差异（分别为 0.589 和 0.58，p = 0.691）。在单独的多变量分析中，PSA 密度和 PSA 是生化失败的重要独立预测因子。相对于使用 PSA 的模型（指数 C 分别为 0.589 和 0.581），使用 PSA 密度的多变量模型在风险评估方面仅略有改善。为了确定使用 PSA 密度作为分类变量是否会改善预后，我们评估了 PSA 密度以确定提供最大风险分层的截止点。 PSA 密度阈值小于 0.4、0.4 至 1 和大于 1 ng./ml./cc 将患者分为 3 个不同的组，生化失败的风险增加 (p < 0.001)。虽然这些临界值比 PSA 密度作为连续变量进行检查时提供了更好的风险分层（指数 C = 0.684 与 0.58），但相对于小于 10、10 至 20 和大于 20 ng./ml 的标准 PSA 临界值，它们仅提供了边际改善。 （指数 C = 0.676）。结论：相对于 PSA，使用术前 PSA 密度仅对预测根治性前列腺切除术后不良病理结果和生化复发有轻微改善。 PSA 密度所提供的术前风险评估的最小且统计上微不足道的改善并不能证明计算该值所需的时间和精力是合理的。
Purpose: Prostate specific antigen (PSA) density based on the surgical weight of the radical prostatectomy specimen has previously been shown to be an independent predictor of biochemical recurrence after radical prostatectomy. We determined whether preoperative PSA density calculated using transrectal ultrasound prostate volume was a better predictor of advanced pathological findings or biochemical recurrence after radical prostatectomy relative to PSA.Materials and Methods: We examined 552 men from the newly established Shared Equal Access Regional Cancer Hospital data base of men treated with radical prostatectomy at equal access medical centers to determine whether preoperative PSA density was a significant predictor of an adverse pathological condition or PSA recurrence after radical prostatectomy. Models using PSA density were compared with models using PSA to determine whether PSA density improved risk stratification relative to PSA. PSA density was examined as a continuous and a categorical variable using cutoffs to separate patients into groups at different risks for PSA failure.Results: PSA density and PSA were significant predictors of adverse pathological findings on univariate analysis. Using PSA density in the multivariate model resulted in slightly better but statistically insignificant improvement in prediction of positive surgical margins (p = 0.134) and extracapsular extension (p = 0.771) relative to using PSA in the model. Neither PSA nor PSA density were significant independent predictors of seminal vesicle invasion. Area under the ROC curves for predicting biochemical recurrence for PSA and PSA density were not significantly different (0.589 and 0.58, respectively, p = 0.691). On separate multivariate analyses PSA density and PSA were significant independent predictors of biochemical failure. The multivariate model using PSA density provided only slight improvement in risk assessment relative to the model using PSA (index C = 0.589 and 0.581, respectively). To determine whether using PSA density as a categorical variable would result in improved prognostication we evaluated PSA density to determine the cutoff points that would provide the greatest risk stratification. PSA density cutoffs of less than 0.4, 0.4 to 1 and greater than 1 ng./ml./cc separated patients into 3 distinct groups at increasing risk for biochemical failure (p < 0.001). While these cutoffs provided better risk stratification than when PSA density was examined as a continuous variable (index C = 0.684 versus 0.58), they provided only marginal improvement relative to the standard PSA cutoffs of less than 10, 10 to 20 and greater than 20 ng./ml. (index C = 0.676).Conclusions: The use of preoperative PSA density relative to PSA provided only slight improvement for predicting adverse pathological findings and biochemical recurrence after radical prostatectomy. The minimal and statistically insignificant improvement in preoperative risk assessment provided by PSA density does not justify the time and effort necessary to calculate this value.