Prostate Health Index and %p2PSA Predict Aggressive Prostate Cancer Pathology in Chinese Patients Undergoing Radical Prostatectomy
Prostate Health Index and %p2PSA Predict Aggressive Prostate Cancer Pathology in Chinese Patients Undergoing Radical Prostatectomy
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DOI：
10.1245/s10434-016-5183-6
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发表时间：
2016-08-01
影响因子：
3.7
通讯作者：
Ng, Chi-Fai
中科院分区：
文献类型：
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作者：
Chiu, Peter Ka-Fung;Lai, Fernand Mac-Moune;Ng, Chi-Fai
为探讨前列腺健康指数（PHI）和前列腺特异性抗原（PSA）亚型[-2]proPSA（%p2PSA）在中国人群中预测根治性前列腺切除术（RP）病理结局的性能，我们对135例RP患者进行了前瞻性研究。采用多变量分析和曲线下面积计算术前%p2PSA（= p2PSA/free PSA）和PHI [=（p2PSA/free PSA）× aePSA]预测RP病理结局的准确性，包括pT 3疾病、病理Gleason评分（pGS）≥ 7、RP时Gleason评分（GS）升高、肿瘤体积> 0.5 ml和Epstein显著肿瘤标准。多变量分析的基础模型包括年龄、PSA、直肠指检异常和活检GS。在pT 3或pGS >= 7的患者中，001）、pT 3疾病（p = 0.001）、pGS >= 7（p < 0.001）、GS升级（p <0.001）、肿瘤体积> 0.5 ml（p <0.001）和Epstein显著肿瘤标准（p = 0.001）。在所有上述结果中，%p2PSA也显著较高。pT 3或pGS >= 7的风险为16.1%< 35 and 60.8 % for PHI >（敏感性84.2%，特异性60.3%），肿瘤体积> 0.5 ml的风险为25.5%< 35 and 72.6 % for PHI >（敏感性79.1%，特异性67.2%）。在多变量分析中，将%p2PSA或PHI添加到基础模型中显著提高了预测pT 3或pGS >= 7（7.2- 7.9%）、肿瘤体积> 0.5 ml（10.3- 12.8%）和Epstein显著肿瘤标准（13.9- 15.9%）的准确性（曲线下面积）。在预测肿瘤体积> 0.5 ml和pT 3或pGS >= 7的决策曲线分析中观察到净临床益处。在中国男性RP中，PHI和%p2PSA均预测侵袭性和显著病理。这使得能够识别非侵袭性癌症，以便更好地进行主动监测或治疗。
To investigate the performance of prostate health index (PHI) and percentage prostate-specific antigen (PSA) isoform [-2]proPSA (%p2PSA) in predicting pathologic outcomes at radical prostatectomy (RP) in a Chinese population.We performed a prospective study of 135 prostate cancer patients with RP. The accuracy of preoperative %p2PSA (= p2PSA/free PSA) and PHI [= (p2PSA/free PSA) x aePSA] in predicting pathologic outcomes of RP including pT3 disease, pathologic Gleason score (pGS) >= 7, Gleason score (GS) upgrade at RP, tumor volume > 0.5 ml, and Epstein criteria for significant tumor were calculated using multivariate analyses and area under the curve. The base model in multivariate analysis included age, PSA, abnormal digital rectal examination, and biopsy GS.PHI was significantly higher in patients with pT3 or pGS >= 7 (p < 0.001), pT3 disease (p = 0.001), pGS >= 7 (p < 0.001), GS upgrade (p < 0.001), tumor volume > 0.5 ml (p < 0.001), and Epstein criteria for significant tumor (p = 0.001). %p2PSA was also significantly higher in all the above outcomes. The risk of pT3 or pGS >= 7 was 16.1 % for PHI < 35 and 60.8 % for PHI > 35 (sensitivity 84.2 %, specificity of 60.3 %), and the risk of tumor volume > 0.5 ml was 25.5 % for PHI < 35 and 72.6 % for PHI > 35 (sensitivity 79.1 %, specificity 67.2 %). In multivariate analysis, adding %p2PSA or PHI to the base model significantly improved the accuracy (area under the curve) in predicting pT3 or pGS >= 7 (by 7.2-7.9 %), tumor volume > 0.5 ml (by 10.3-12.8 %), and Epstein criteria for significant tumor (by 13.9-15.9 %). Net clinical benefit was observed in decision curve analyses for prediction of both tumor volume > 0.5 ml, and pT3 or pGS >= 7.Both PHI and %p2PSA predict aggressive and significant pathologies in RP in Chinese men. This enabled identification of nonaggressive cancers for better counseling on active surveillance or treatment.