f/t PSA、PSAD、(f/t)/PSAD在PSA 4~20 μg/L区间对前列腺癌的诊断预测价值

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摘要目的:通过对fPSA、f/t PSA、PSAD、fPSAD、(f/t)/PSAD指标的分析,评价对PSA灰区(4~20 μg/L)前列腺癌的诊断预测价值。方法:回顾性分析根据筛选条件纳入病例347例,按tPSA水平分为4 μg/L＜tPSA≤10 μg/L、10 μg/L＜tPSA＜20 μg/L两个区间,分别对各项指标进行统计学分析。结果:①tPSA 4 μg/L＜tPSA≤10 μg/L患者222例,腺癌阳性率为49.6%;10 μg/L＜tPSA＜20 μg/L患者125例,腺癌阳性率为64.0%,二者比较差异有统计学(P＜0.05)。②在tPSA 4 μg/L＜tPSA≤10 μg/L及10 μg/L＜tPSA＜20 μg/L,腺癌与增生两组间年龄、BMI、tPSA、f/tPSA、fPSAD值均差异无统计学意义(P＞0.05);腺癌组较增生组fPSA及(f/t)/PSAD值显著降低(P＜0.05);PSAD值在tPSA 10 μg/L＜tPSA＜20 μg/L时,腺癌组较增生组显著升高(P＜0.05),而在4 μg/L＜tPSA≤10 μg/L时无差异(P＞0.05)。③绘制ROC曲线,tPSA在4 μg/L＜tPSA≤10 μg/L及10 μg/L＜tPSA＜20 μg/L时,AUC值大小顺序一致,依次为PSAD＞(f/t)/PSAD＞f/t PSA＞fPSA＞fPSAD。其中PSAD、(f/t)/PSAD值的敏感度、特异度均高;f/t值有较高的敏感度,但特异度一般;fPSA、fPSAD在tPSA 4 μg/L＜tPSA≤10 μg/L时敏感度较高而特异度低,但在tPSA10 μg/L＜tPSA＜20 μg/L时敏感度及特异度相近。结论:在PSA灰区内,fPSA、f/t PSA、PSAD、fPSAD、(f/t)/PSAD等指标的运用对于诊断预测前列腺癌具有重要价值,其中f/t PSA、PSAD、(f/t)/PSAD的诊断效能更好,值得进一步开展研究。

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	马明辉
	黄庆波
	高宇
	赵超飞
	刘侃
	史涛坪
	马鑫
	张旭

关键词 ：前列腺特异性抗原, 前列腺特异性抗原密度, 前列腺癌, 诊断

Abstract：Objective: To evaluate predicted value of prostate specific antigen (PSA) and its related indexes in the diagnosis of prostate cancer (PCa). Methods: A total of 347 cases with tPSA range of 4-20 μg/L, were divided into two groups according to the tPSA levels. The various indexes, including fPSA, f/t PSA, PSAD, fPSAD, (f/t)/PSAD were analyzed. Results: In 222 patients with tPSA range of 4-10 μg/L, the positive rate of prostatic adenocarcinoma was 49.6%, and in the remaining 125 patients with tPSA range of 10-20 μg/L, that was 64.0% (P<0.05). There was no significant difference between PCa group and benign prostatic hyperplasia (BPH) group in age, BMI, tPSA, f/tPSA, and fPSAD. fPSA and (f/t)/PSAD were significantly lower in PCa group. ROC analysis indicated that PSAD and (f/t)/PSAD had the highest AUC value. For the cutoff values of 0.13 for PSAD, the sensitivity was 84.5% and specificity was 83.9%, and the AUC was 0.685. For the cutoff values of 1.26 for (f/t)/ PSAD, the sensitivity was 80.4% and specificity was 82.7%, and the (AUC) was 0.631. Conclusions: f/t PSA, PSAD and (f/t)/PSAD might be more effective in the基金项目:国家高技术研究发展计划(863计划) (2014AA020607)differential diagnosis between PCa and BPH with tPSA range of 4-20 μg/L.

Key words： prostate specific antigen prostate specific antigen density prostatic neoplasms diagnosis

收稿日期: 2015-09-17

ZTFLH:

R737.2

基金资助:国家高技术研究发展计划(863计划) (2014AA020607)

通讯作者: 张旭 E-mail: xzhang@foxmail.com

引用本文:

马明辉,黄庆波,高宇,赵超飞,刘侃,史涛坪,马鑫,张旭. f/t PSA、PSAD、(f/t)/PSAD在PSA 4~20 μg/L区间对前列腺癌的诊断预测价值[J]. 微创泌尿外科杂志, 2015, 4(6): 366-371.
Ma Minghui , Huang Qingbo , Gao Yu , Zhao Chaofei , Liu Kan , Shi Taoping , Ma Xin , Zhang Xu. Predicted value of free-to-total prostate specific antigen (f/t PSA), prostate specific antigen density (PSAD) and (f/t)/PSAD in the diagnosis of prostate cancer with PSA between 4 and 20 μg/L. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(6): 366-371.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract836.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2015/V4/I6/366

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