Clinical significance of the LacdiNAc‐glycosylated Prostate‐Specific Antigen Assay for prostate cancer detection
Clinical significance of the LacdiNAc‐glycosylated Prostate‐Specific Antigen Assay for prostate cancer detection
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LacdiNAc 糖基化前列腺特异性抗原测定对前列腺癌检测的临床意义
DOI：
10.1111/cas.14082
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发表时间：
2019
期刊：
影响因子：
5.7
通讯作者：
Gardiner
中科院分区：
文献类型：
--
作者：
Yoneyama Tohru;Tobisawa Yuki;Kaneko Tomonori;Kaya Takatoshi;Hatakeyama Shingo;Mori Kazuyuki;Sutoh Yoneyama Mihoko;Okubo Teppei;Mitsuzuka Koji;Duivenvoorden Wilhelmina;Pinthus Jehonathan H.;Hashimoto Yasuhiro;Ito Akihiro;Koie Takuya;Suda Yoshihiko;Gardiner
为了减少不必要的前列腺活检（Pbx），需要更好的区分。为了鉴定具有临床意义的前列腺癌（CSPC），我们确定了LacdiNAc-糖基化前列腺特异性抗原（LDN-PSA）和前列腺体积标准化的LDN-PSA（LDN-PSAD）的性能。我们回顾性测量了日本和加拿大3家学术泌尿科诊所接受Pbx的718名男性（Pbx队列）和随后在澳大利亚接受根治性前列腺切除术的174名PC患者（术前PSA队列）的LDN-PSA、总PSA（tPSA）和游离PSA/tPSA（F/T PSA）值。使用受试者工作特征曲线下面积（AUC）和决策曲线分析对测定进行评价，以区分CSPC。在Pbx队列中，LDN-PSAD（AUC 0.860）在区分CSPC方面的临床表现显著优于LDN-PSA（AUC 0.827，P = 0.0024）、PSAD（AUC 0.809，P < 0.0001）、tPSA（AUC 0.712，P < 0.0001）和F/T PSA（AUC 0.661，P < 0.0001）。决策曲线分析显示，使用20%的风险阈值并将LDN-PSA和LDN-PSAD添加到基础模型（年龄、直肠指检状态、tPSA和F/T PSA）中，可以避免更多活检，而不会缺失CSPC（分别为9.89%和18.11% vs 2.23% [基础模型]）。在术前PSA队列中，LDN-PSA值与肿瘤体积和tPSA呈正相关，pT 3、病理Gleason评分≥ 7时显著更高。局限性包括样本量有限、回顾性、活检前无家族史信息。LacdiNAc-糖基化PSA在识别CSPC患者方面明显优于传统PSA检测。本研究已获得各机构伦理委员会的批准（“泌尿系统疾病中碳水化合物结构变化的研究”;批准编号2014 - 195）。
To reduce unnecessary prostate biopsies (Pbx), better discrimination is needed. To identify clinically significant prostate cancer (CSPC) we determined the performance of LacdiNAc‐glycosylated prostate‐specific antigen (LDN‐PSA) and LDN‐PSA normalized by prostate volume (LDN‐PSAD). We retrospectively measured LDN‐PSA, total PSA (tPSA), and free PSA/tPSA (F/T PSA) values in 718 men who underwent a Pbx in 3 academic urology clinics in Japan and Canada (Pbx cohort) and in 174 PC patients who subsequently underwent radical prostatectomy in Australia (preop‐PSA cohort). The assays were evaluated using the area under the receiver operating characteristics curve (AUC) and decision curve analyses to discriminate CSPC. In the Pbx cohort, LDN‐PSAD (AUC 0.860) provided significantly better clinical performance for discriminating CSPC compared with LDN‐PSA (AUC 0.827,P= 0.0024), PSAD (AUC 0.809,P< 0.0001), tPSA (AUC 0.712,P< 0.0001), and F/T PSA (AUC 0.661,P< 0.0001). The decision curve analysis showed that using a risk threshold of 20% and adding LDN‐PSA and LDN‐PSAD to the base model (age, digital rectal examination status, tPSA, and F/T PSA) permitted avoidance of even more biopsies without missing CSPC (9.89% and 18.11%, respectively vs 2.23% [base model]). In the preop‐PSA cohort, LDN‐PSA values positively correlated with tumor volume and tPSA and were significantly higher in pT3, pathological Gleason score ≥ 7. Limitations include limited sample size, retrospective nature, and no family history information prior to biopsy. LacdiNAc‐glycosylated PSA is significantly better than the conventional PSA test in identifying patients with CSPC. This study was approved by the ethics committee of each institution (“The Study about Carbohydrate Structure Change in Urological Disease”; approval no. 2014‐195).