无骨转移症状前列腺癌患者免于骨扫描的临床研究

摘要

目的：探讨前列腺特异性抗原(PSA)<20 ng/ml 和 Gleason评分<8分无骨转移症状前列腺癌患者免于骨扫描的截点是否适用于我国，并探寻适用于国人的截点。方法回顾性分析我院2003年5月至2012年12月经病理确诊并行骨扫描检查的无骨转移症状前列腺癌患者257例，对年龄、碱性磷酸酶、PSA值、Gleason评分、骨扫描结果等临床资料进行统计分析。结果骨转移阳性67例(26.1%)；骨转移阳性组PSA值、Gleason评分与骨转移阴性组差异具有统计学意义(P<0.05)。PSA水平、Gleason 评分越高，骨转移发生率增高(P<0.05)。单因素及多因素Logistic回归分析示PSA、Gleason评分为骨转移的独立预测因子。PSA<10 ng/ml 和 Gleason 评分≤6分的35例中无骨转移阳性病例(阴性预测值100%)，而 PSA<20 ng/ml 和 Gleason评分<8分的81例中3例骨转移阳性(阴性预测值96.3%)。结论 PSA 值、Gleason 评分是骨转移阳性的独立预测因子；PSA<20 ng/ml和 Gleason评分<8可免于骨扫描的截点并不适用于我国，而以PSA<10 ng/ml和Gleason评分≤6作为截点可能更适用于我国。%Objective To investigate if it is suitable for our country to set prostate-specific an-tigen (PSA)level<20 ng/ml and Gleason score<8 as the cut point below which a bone scan can be spared in prostate cancer patients with no symptoms of bone metastases,and the suitable cut point for us. Methods We retrospectively reviewed the charts of 257 consecutive patients with a pathol-ogy diagnosis of prostate cancer hospitalized in our department between May.2003 and Dec.2012, and evaluated age,serum tPSA,Gleason sum and bone scan. Results 67 (26.1%)patients got positive results.The serum PSA levels and Gleason score were significantly higher (P<0.05)in patients with positive results of the bone scan than those with negative results.With the increase of PSA level and Gleason score,the incidence of bone metastasis increased (P<0.05).Univariate and multivariate logistic regression analyses suggested that PSA level and Gleason score were independent predictors of bone metas-tasis.None of the 35 patients with PSA level<10 ng/ml and Gleason score ≤6 had positive results (negative predictive value was 100%),3 of 81 patients with the PSA level <20 ng/ml and Gleason score<8 had positive results (negative predictive value was 96.3%). Conclusions PSA level and Gleason score are independent predictors of bone metastasis.It is suitable for our country to set PSA level<10 ng/ml and Gleason score≤6 as the cut point below which a bone scan can be spared in prostate cancer patients with no symptoms of bone metastases,but not the PSA level<20 ng/ml and Gleason score<8.