前列腺活检和根治性前列腺切除术Gleason分级组的一致性和用于预测升级和降级的形态图建立

Q4 Medicine

中华泌尿外科杂志 Pub Date : 2019-09-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2019.09.006

Xiangyi Zheng, Huaqing Yan, Liujia He, Jianjian Xiang, X. Teng, Liping Xie

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The median percentage of positive puncture cores was 0.25 (ranging 0.08-1.00). There were 161 patients in clinical stage ≤T1c, 344 patients in T2a-T2c and 165 patients in clinical stage ≥T3. 670 cases all accepted the radical prostatectomy. Consistency of prostate biopsy and radical prostatectomy Gleason grade was recorded. If the postoperative Gleason grade was higher than that in biopsy, it was defined as upgrade. Otherwise, it was defined as downgrade. Multivariate logistic regression model was used to evaluate the influencing factors leading to upgrades in GR1 patients or downgrades in GR2 patients. Nomograms were drawn based on the models with AUC and Horsmer-Lemeshaw test conducted to test the discrimination and calibration of the models. \n \n \nResults \nAmong the 670 patients included, 165 cases (50.0% of GR1) upgrades and 27 cases (7.9% of GR2) downgrades. PSAD≥0.25(OR=3.015) and clinical stage≥T2b(OR=7.185)were independent influencing factors for the upgrade in GR1 patients, while PSAD<0.15(OR=4.208) and clinical stage≤T1c(OR=4.530) were independent influencing factors for downgrade. The nomograms were drawn with the above variables. The AUC of the model (0.781 for GR1 group, 0.741 for GR2 group) and the hosmer-remeshaw test results (P=0.993 for GR1 group, P=0.234 for GR2 group) show that the nomograms have good discrimination and calibration. \n \n \nConclusions \nPSAD and clinical stage are independent influencing factors for the upgrade or downgrade. Nomograms may provide help for clinicians to judge the accuracy of prostate biopsy. 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引用次数: 0

摘要

目的评价前列腺活检与术后病理分级的一致性，分析可能导致升级或降级的影响因素，并建立预测模型。方法回顾性分析2013年1月至2018年12月浙江大学医学院第一附属医院活检GS3+ 3=6例(GR1 330例)和GS3+ 4=7例(GR2 340例)患者的临床资料。年龄中位数为67岁(35 - 100岁)。BMI中位数为23.74 kg/m2(16.22 ~ 38.74 kg/m2)。中位tPSA为10.266 ng/ml(范围为0.017-147.575 ng/ml)。前列腺容积中位数为29.43 ml(5.92 ~ 187.20 ml)。PSAD中位数为0.34(范围0.01-4.02)。中位穿刺阳性百分率为0.25(范围为0.08-1.00)。临床分期≤T1c 161例，T2a-T2c 344例，≥T3 165例。670例均行根治性前列腺切除术。记录前列腺活检和根治性前列腺切除术的Gleason分级的一致性。如果术后Gleason分级高于活检时，则定义为升级。否则，它被定义为降级。采用多因素logistic回归模型评价导致GR1级患者升级或GR2级患者降级的影响因素。在模型基础上绘制nomogram，并通过Horsmer-Lemeshaw检验检验模型的辨别性和定标性。结果670例患者中，升级165例(占GR1的50.0%)，降级27例(占GR2的7.9%)。PSAD≥0.25(OR=3.015)、临床分期≥T2b(OR=7.185)是GR1级患者降级的独立影响因素，PSAD<0.15(OR=4.208)、临床分期≤T1c(OR=4.530)是GR1级患者降级的独立影响因素。用上述变量绘制了图。模型的AUC (GR1组为0.781,GR2组为0.741)和hosmer-remeshaw检验结果(GR1组为P=0.993, GR2组为P=0.234)表明，该模态图具有良好的判别性和定标性。结论PSAD和临床分期是影响升级或降级的独立因素。前列腺造影可以帮助临床医生判断前列腺活检的准确性。但在临床实践中仍需对其进行验证。关键词:前列腺肿瘤;格里森评分;前列腺活检;根治性前列腺切除术

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Consistency of prostate biopsy and radical prostatectomy Gleason grade groups and nomograms establishment for predicting upgrading and downgrading

Objective To evaluate the consistency between prostate biopsy and postoperative pathological grade, analyze the influencing factors that may lead to upgrade or downgrade, and to establish a prediction model. Methods The clinical data of biopsy GS3+ 3=6(GR1, 330 cases) and GS3+ 4=7(GR2, 340 cases) patients from January 2013 to December 2018 in the first affiliated hospital, College of Medicine of Zhejiang university were retrospectively analyzed. The median age was 67 years old(ranging 35 to 100 years old). The median BMI was 23.74 kg/m2(ranging 16.22-38.74 kg/m2). The Median tPSA was 10.266 ng/ml(ranging 0.017-147.575 ng/ml). The median prostate volume was 29.43 ml(5.92-187.20 ml). The median PSAD was 0.34 (ranging 0.01-4.02). The median percentage of positive puncture cores was 0.25 (ranging 0.08-1.00). There were 161 patients in clinical stage ≤T1c, 344 patients in T2a-T2c and 165 patients in clinical stage ≥T3. 670 cases all accepted the radical prostatectomy. Consistency of prostate biopsy and radical prostatectomy Gleason grade was recorded. If the postoperative Gleason grade was higher than that in biopsy, it was defined as upgrade. Otherwise, it was defined as downgrade. Multivariate logistic regression model was used to evaluate the influencing factors leading to upgrades in GR1 patients or downgrades in GR2 patients. Nomograms were drawn based on the models with AUC and Horsmer-Lemeshaw test conducted to test the discrimination and calibration of the models. Results Among the 670 patients included, 165 cases (50.0% of GR1) upgrades and 27 cases (7.9% of GR2) downgrades. PSAD≥0.25(OR=3.015) and clinical stage≥T2b(OR=7.185)were independent influencing factors for the upgrade in GR1 patients, while PSAD<0.15(OR=4.208) and clinical stage≤T1c(OR=4.530) were independent influencing factors for downgrade. The nomograms were drawn with the above variables. The AUC of the model (0.781 for GR1 group, 0.741 for GR2 group) and the hosmer-remeshaw test results (P=0.993 for GR1 group, P=0.234 for GR2 group) show that the nomograms have good discrimination and calibration. Conclusions PSAD and clinical stage are independent influencing factors for the upgrade or downgrade. Nomograms may provide help for clinicians to judge the accuracy of prostate biopsy. However, the nomograms still needs to be verified in clinical practice Key words: Prostate neoplasms; Gleason score; Prostate biopsy; Radical prostatectomy

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.