Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study
Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study
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经直肠和经会阴前列腺活检的诊断效果比较：倾向评分匹配研究
DOI：
10.4103/aja.aja_16_19
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发表时间：
2019-11-01
影响因子：
2.9
通讯作者：
Zhao, Fu-Jun
中科院分区：
文献类型：
--
作者：
Jiang, Chen-Yi;Shen, Peng-Fei;Zhao, Fu-Jun
本研究比较了经直肠超声（TRUS）引导下前列腺活检（TRBx）和经会阴前列腺活检（TPBx）在疑似前列腺癌（PCa）患者中的诊断效果。我们招募了2962名接受经直肠（n = 1216）或经会阴（n = 1746）系统性12芯前列腺活检的男性。记录患者的年龄、前列腺特异性抗原（PSA）水平和前列腺体积（PV）等临床资料。为了尽量减少混杂，我们进行了倾向评分匹配分析。我们测量并比较了TRBx和TPBx之间的PCa检出率，并根据临床特征和Gleason评分进行分层。Logistic回归分析临床特征对PCa检出率的影响。对于所有患者，TPBx检测到临床显著PCa的比例较高（P < 0.001）。Logistic回归分析显示，PV对TPBx PCa检出率的影响小于TRBx。倾向性评分匹配分析显示，年龄>-80岁（80.4%vs56.5%，P = 0.004）和PSA水平20.1- 100.0ng/ml（80.8%vs69.1%，P = 0.040）的患者TRBx的检出率高于TPBx。总之，TPBx与临床显著PCa的检出率高于TRBx相关;然而，由于某些年龄和PSA水平的检出率较高，因此应根据患者的临床特征优化活检方法。
This study compared the diagnostic efficacy of transrectal ultrasound (TRUS)-guided prostate biopsy (TRBx) and transperineal prostate biopsy (TPBx) in patients with suspected prostate cancer (PCa). We enrolled 2962 men who underwent transrectal (n = 1216) or transperineal (n = 1746) systematic 12-core prostate biopsy. Clinical data including age, prostate-specific antigen (PSA) level, and prostate volume (PV) were recorded. To minimize confounding, we performed propensity score-matching analysis. We measured and compared PCa detection rates between TRBx and TPBx, which were stratified by clinical characteristics and Gleason scores. The effects of clinical characteristics on PCa detection rate were assessed by logistic regression. For all patients, TPBx detected a higher proportion of clinically significant PCa (P < 0.001). Logistic regression analyses illustrated that PV had a smaller impact on PCa detection rate of TPBx compared with TRBx. Propensity score-matching analysis showed that the detection rates in TRBx were higher than those in TPBx for patients aged >- 80 years (80.4% vs 56.5%, P = 0.004) and with PSA level 20.1-100.0 ng ml(-1) (80.8% vs 69.1%, P = 0.040). In conclusion, TPBx was associated with a higher detection rate of clinically significant PCa than TRBx was; however, because of the high detection rate at certain ages and PSA levels, biopsy approaches should be optimized according to patents' clinical characteristics.