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目的:联合应用血清总前列腺特异性抗原(tPSA),游离前列腺特异性抗原(fPSA)及结合前列腺特异性抗原(cPSA),构建出新的前列腺癌(PCa)预测模型:tPSA/fPSA×cPSA1/2,即前列腺癌预测因子(PCP),进而评估PCP诊断PCa的临床应用价值。方法:从我院2011年12月1日~2014年12月1日期间的病例中,筛选出拥有明确病理报告且术前血清前列腺特异性抗原(PSA)检查结果满足2≤tPSA<10ng/ml的PCa患者54例,BPH患者579例;满足10≤tPSA<20ng/ml的PCa患者48例,BPH患者147例。应用Logestic regression及ROC曲线对比分析tPSA、fPSA、fPSA与tPSA的比值(f/tPSA)、cPSA及PCP诊断PCa的价值,应用列线图分析PCP预测PCa的能力。结果:在PCa及BPH两组间,tPSA、f/tPSA、cPSA与PCP的中位数(9.2,5.5;0.13,0.19;8.0,4.4;22.1,11.0)均存在明显差异(P<0.000)。当2≤tPSA<10ng/ml时:PCP的ROC曲线下面积(AUC)为0.680,明显高于tPSA的0.588、fPSA的0.571、f/tPSA的0.675、cPSA的0.613;在诊断PCa的敏感性均为90.7%左右的前提下,PCP诊断PCa的特异性为22.8%,明显高于tPSA的11.1%、fPSA的11.2%、f/tPSA的17.4%、cPSA的15.5%。当10≤tPSA<20ng/ml时:PCP的ROC曲线下面积为0.686,明显高于tPSA的0.603、fPSA的0.643、f/tPSA的0.679、cPSA的0.647;在诊断PCa的敏感性均为91%左右的前提下,PCP诊断PCa的特异性为29.3%,明显高于tPSA的10.9%、fPSA的10.2%、f/tPSA的23.1%、cPSA的18.4%。结论:当2≤tPSA<10ng/ml或10≤tPSA<20ng/ml时,PCP明显较PSA、fPSA、f/tPSA、cPSA对PCa更具预测价值。
OBJECTIVE: To construct a new predictive model of prostate cancer (PCa) by combining serum total prostate specific antigen (tPSA), free prostate specific antigen (fPSA) and prostate specific antigen (cPSA) with tPSA / fPSA × cPSA1 / 2, Prostate Cancer Predictor (PCP), and then evaluate the clinical value of PCP in the diagnosis of PCa. Methods: From December 1, 2011 to December 1, 2014 in our hospital, we screened out the patients with clear pathology and the results of preoperative serum PSA test meet 2≤tPSA <10ng / ml 54 cases of PCa patients and 579 cases of BPH patients; 48 cases of PCa patients and 147 cases of BPH patients meeting 10≤tPSA <20ng / ml. The ratio of tPSA, fPSA, fPSA to tPSA (f / tPSA) was compared with PCA by using Logestic regression and PCP. The PCa value of PCa was determined by using cPSA and PCP. Results: There was a significant difference (P <0.000) between the median of tPSA, f / tPSA, cPSA and PCP in PCa and BPH groups (9.2,5.5; 0.13,0.19; 8.0,4.4; 22.1,11.0). When 2≤tPSA <10ng / ml, the area under the ROC curve (PCC) of PCP was 0.680, significantly higher than that of tPSA 0.588, fPSA 0.571, f / tPSA 0.675, cPSA 0.613; The specificity of PCP in diagnosing PCa was about 22.8%, which was significantly higher than that of tPSA (11.1%), fPSA (11.2%), f / tPSA (17.4%) and cPSA (about 90.7%). When 10≤tPSA <20ng / ml, the area under the ROC curve of PCP was 0.686, significantly higher than 0.603 of tPSA, 0.643 of fPSA, 0.679 of f / tPSA and 0.647 of cPSA. The sensitivity of PCP in diagnosing PCa was 91% , The specificity of PCP in diagnosing PCa was 29.3%, significantly higher than 10.9% of tPSA, 10.2% of fPSA, 23.1% of f / tPSA and 18.4% of cPSA. Conclusions: When 2≤tPSA <10ng / ml or 10≤tPSA <20ng / ml, PCP is more predictive of PCa than PSA, fPSA, f / tPSA and cPSA.