前列腺根治性切除术后Gleason分组高于活检Gleason分组的相关因素

Factors Associated with a Higher Gleason Group after Radical Prostatectomy Compared to the Biopsy Gleason Group

摘要: 目的：探讨前列腺根治术后2014年国际泌尿病理协会病理分组升高的相关因素。方法：回顾性分析新疆维吾尔自治区人民医院2016年6月~2023年6月期间行前列腺根治切除术患者的临床资料，收集患者年龄、BMI、根治穿刺时间间隔、单核细胞计数、中性粒细胞计数、淋巴细胞计数、NLR、tPSA、fPSA、f/tPSA、PV、PSAD、穿刺术后Gleason评分、穿刺阳性针数、评分最高针肿瘤组织占比、根治术后Gleason评分、内分泌治疗史、高血压史和糖尿病史。分别在中体患者和活检Gleason分组 = 1亚组中分析根治术后Gleason分组升高的相关因素。结果：共纳入170名患者，在总体患者中，50 (29.4%)名根治术后Gleason分组高于活检Gleason分组，经过单因素分析与多因素logistics回归分析，仅活检Gleason分组(p = 0.000, OR = 0.575)是根治术后Gleason分组升高的独立危险因素。进一步用ROC曲线分析，AUC为0.316 (95%CI: 0.237~0.394)。活检Gleason分组 = 1亚组共57名患者，其中22 (38.6%)名患者根治术后Gleason分组上升。PSAD (0.024)及临床T分期(0.009)是根治术后Gleason评分升高的独立危险因素。其AUC分别为：0.806 (95%CI: 0.683~0.903)和0.786 (95%CI: 0.666~0.907)。结论：约29.4%的前列腺癌患者会出现根治术后Gleason分组升级，其中活检Gleason分组 ≤ 3的患者有较高的升级风险。在活检Gleason分组 = 1的患者中，PSAD和临床T分期是根治术后Gleason分组升高的预测因素，具有一定的预测价值。

Abstract: Objective: To investigate the factors related to the increase of the pathologic group of the Interna-tional Urological Pathology Association in 2014 after radical prostatectomy. Method: Clinical data of patients undergoing radical prostatectomy in the People’s Hospital of Xinjiang Uygur Autonomous Region from June 2016 to June 2023 were retrospectively analyzed. Patients’ age, BMI, radical puncture interval, monocyte count, neutrophil count, lymphocyte count, NLR, tPSA, fPSA, f/tPSA, PV, PSAD, Gleason score after puncture, number of positive needles, proportion of tumor tissue with the highest score, Gleason score after radical surgery, history of endocrine therapy, history of hyperten-sion and history of diabetes were collected. Factors associated with the elevation of Gleason group after radical surgery were analyzed in the middle body patients and in the biopsy Gleason group = 1 subgroup. Result: A total of 170 patients were included. Among the total number of patients, 50 (29.4%) had higher Gleason group after radical surgery than biopsy Gleason group. After univariate analysis and multi-factor logistics regression analysis, Biopsy Gleason group alone (p = 0.000, OR = 0.575) was an independent risk factor for increased Gleason group after radical surgery. Further ROC curve analysis showed that the AUC was 0.316 (95%CI: 0.237~0.394). The Gleason group of biopsy = 1 subgroup of 57 patients, of which 22 (38.6%) patients had increased Gleason group after radical surgery. PSAD (0.024) and clinical T stage (0.009) were independent risk factors for in-creased Gleason score after radical surgery. The AUC was 0.806 (95%CI: 0.683~0.903) and 0.786 (95%CI: 0.666~0.907), respectively. Conclusions: About 29.4% of prostate cancer patients will have Gleason group escalation after radical surgery, and patients with Gleason group ≤ 3 on biopsy have a higher risk of escalation. In patients with biopsy Gleason group = 1, PSAD and clinical T stage are predictors of increased Gleason group after radical surgery, and have some predictive value.