前列腺癌临床各因素与预后的关系分析

摘要

目的 探讨前列腺癌(PCa)患者年龄、前列腺特异性抗原密度(PSAD)、Gleason评分、临床分期、骨转移等临床因素与其预后的关系.方法 回顾分析2005年6月至2009年1月病检确诊为前列腺癌,有完整前列腺特异性抗原(PSA)及发射单电子计算机断层扫描(ECT)、CT/MRI、X线和B超检查资料,能够准确进行TNM分期及计算PSAD的57例患者.结果 年龄与临床分期(T)呈正相关(r=0.287,P<0.01),PSAD与T呈正相关(r=0.321,P<0.01),并与Gleason评分也呈正相关(r=0.327,P<0.01),T与Gleason评分呈正相关(r=0.250,P<0.01).而年龄与Gleason评分间差异无统计学意义(P>0.05).死亡组与非死亡组比较,骨转移、T、PSAD及Gleason评分差异均有统计学意义(P<0.05).Gleason评分大于7分组与小于或等于7分组病死率比较差异有统计学意义(P<0.05).PSAD≤3 ng·mL-1·(cm3)-1组与大于3 ng·mL-1·(cm3)-1组累积生存率比较差异有统计学意义(P<0.01).随访1、2、3、4年患者的累积生存率分别为86%、64%、54%、33%.中位生存时间为43.36个月.结论 骨转移、临床分期、PSAD及Gleason评分与预后存在一定关联;骨转移、PSAD及临床分期是预后的危险因素.以PSAD=3 ng·mL-1·(cm3)-1为分界点,>3 ng·mL-1·(cm3)-1组累积生存率比小于或等于3 ng·mL-1·(cm3)-1组明显降低(P<0.05),PSAD对判断PCa患者预后可能具有一定作用.%Objective To study the relationships between prognosis of patients with prostate cancer( PCa) and age , PSAD, Gleason score, clinical stage and bone metastasis. Methods Clinical data of fifty seven PCa patients was reviewed, who were diagnosed by pathological examination in our hospital between June. 2005 and Jan. 2009, and had complete informations of PSA, ECT, CT/MRI,X ray, B-Ultrasound of prostate,TNM stage and PSAD. Results Age was positively correlated with clinical stage(T) (r =0. 287 ,P＜0. 01) , and PSAD was positively correlated with T(r= 0. 321 , P＜0. 01) and Gleason score( r= 0. 327 , P ＜ 0. 01). T was positively correlated with Gleason score(r= 0. 250, P＜0. 01). Age was not significantly correlated with Gleason score(P＞ 0. 05). Between death group and non-death group,bone metastasis, clinical stage,PSAD and Gleason score were significantly different(P＜0. 05). With Gleason score 7 as a cutoff point,there was a significantly different mortality between ＞7 group and≤7 group (P＜0. 05). With PSAD level 3 ng · mL-1 · (cm3 ) -1 as a cutoff point,there was also a significant different mortality rates between PSAD ≤3 ng · mL-1 · (cm3 )-1 group and ＞3 ng · mL-1 · (cm3 )-1 group(P＜0. 01). 1 , 2 , 3 , 4-year cumulative survival rates were 86％ ,64％ ,54 ％ ,33％ in PCa patients, respectively. The median survival time was 43. 36 months. Conclusion Prognosis of PCa patients are certainly correlated with bone metastasis,clinical stage,PSAD, Gleason score; Bone metastases, PSAD and clinical stage are risk factors for prognosis of PCa patients. The cumulative survival rate of PSAD level ＞3 ng · mL-1 · (cm3 )-1 group is significantly lower than that of ≤3 ng · mL-1 . ( cm3 ) -1 group(P＜0. 05) , thus PSAD may play a key role in determining the prog nosis of PCa patients.