多中心研究PSA≤20 ng/mL前列腺癌临床特点及危险因素分析

Clinical characteristics and risk factors for prostate cancer with PSA≤20 ng/mL: a multicenter study

摘要:

目的 探究前列腺特异抗原（prostate specific antigen，PSA）≤20 ng/mL前列腺癌患者骨转移临床特点及其与临床病理因素的相关性。方法 回顾性分析2011年1月至2017年12月南方医院、珠江医院、南部战区总医院收治的初诊PSA≤20 ng/mL前列腺癌患者临床及病理资料。将患者分为骨转移组和非骨转移组，分析2组间年龄、PSA、结合PSA（complexed PSA，cPSA）、游离PSA（free PSA，fPSA）、Gleason评分（Gleason score，GS）、T分期及N分期的差异，以及这些因素与骨转移的相关性。进一步根据PSA、GS、T分期及N分期情况进行亚组分析：PSA≤10 ng/mL及PSA 10.01~20 ng/mL组、GS≤6组和GS≥7组、T_1~2组和T_3~4组、N₀组及N₁组，探究各亚组间骨转移特点。最后，采用单因素及多因素logistic回归分析评估骨转移危险因素。结果 共237例PSA≤20 ng/mL前列腺癌患者，其中骨转移阳性42例（17.7%）。不同PSA组（<4 ng/mL组、≤10 ng/mL组及10.01~20 ng/mL组）前列腺癌骨转移率分别为7.5%、12.1%和24.8%。骨转移组与非转移组间PSA、cPSA、fPSA、GS、T分期及N分期差异均有统计学意义（P<0.05），但2组间年龄差异无统计学意义（P>0.05）。亚组分析结果显示：随着PSA及GS升高骨转移发生率也明显上升，T_3~4和N₁期患者更易发生骨转移（OR=2.372，95%CI=1.148~4.901，P=0.020；OR=6.458，95%CI=2.435~17.131，P<0.001）。此外，logistic回归分析提示PSA、GS、T分期及N分期与PSA≤20 ng/mL前列腺癌骨转移密切相关，其中PSA、GS及N分期可作为骨转移的独立危险因素（P<0.05）。而年龄与骨转移的发生无相关性（P>0.05）。结论 PSA≤20 ng/mL前列腺癌患者中GS≥7、T_3~4和N₁期患者具有较强的侵袭性。PSA、GS及N分期可作为PSA≤20 ng/mL前列腺癌骨转移的独立危险因素。

Abstract:

Objective To explore the clinical characteristics of bone metastasis and its correlation with clinicopathological factors in patients with prostate cancer with prostate specific antigen（PSA） ≤20 ng/mL.Methods This study retrospectively analyzed the clinical and pathological data of patients who were newly diagnosed with prostate cancer with PSA ≤20 ng/mL in Nanfang Hospital，Zhujiang Hospital，and General Hospital of Southern Theater Command from January 2011 to December 2017. The patients were divided into two groups according to with or without bone metastasis. Differences in age，PSA，complexed PSA（cPSA），free PSA（fPSA），Gleason score（GS），and T and N stages were analyzed between the two groups，and the correlation of these factors with bone metastasis was analyzed. A further subgroup analysis was performed based on PSA levels（≤10 ng/mL and 10.01-20 ng/mL），GS（GS ≤ 6 and GS ≥ 7），T stages（T_1-2 and T_3-4），and N stages（N₀ and N₁） to explore the characteristics of bone metastasis between subgroups. Finally，univariate and multivariate logistic regression analyses were used to identify risk factors for bone metastasis.Results Of all 237 patients involved in this study，42（17.7%） patients showed bone metastases，and the incidence rates of bone metastasis in patients with PSA <4 ng/mL，patients with PSA≤10 ng/mL，and patients with PSA of 10.01-20 ng/mL were 7.5%，12.1%，and 24.8%，respectively. There were significant differences in PSA，cPSA，and fPSA levels，GS，and T and N stages between the patients with and without bone metastasis（P<0.05）. There was no significant difference in age between the two groups（P>0.05）. The subgroup analysis further revealed that with the increases in PSA level and GS，the incidence of bone metastasis was consistently increased，and bone metastasis was more frequent in patients with stage T_3-4 and N₁ disease ［odds ratio（OR）=2.372，95%CI=1.148-4.901，P=0.020；OR=6.458，95%CI=2.435-17.131，P<0.001］. logistic regression analyses showed that PSA level，GS，and T and N stages were closely related to bone metastasis in patients with prostate cancer with PSA ≤20 ng/mL，and PSA level，GS，and N stage were independent risk factors for bone metastasis（P<0.05）. There was no significant association between age and bone metastasis（P>0.05）.Conclusion More tumor aggressiveness is found in patients with GS ≥7 and stage T_3-4 and N₁ disease among patients with prostate cancer with PSA ≤20 ng/mL. PSA level，GS，and N stage are independent risk factors for bone metastasis in patients with prostate cancer with PSA ≤20 ng/mL.