[1]郭晓翔,朱海松,张超,等.血清前列腺特异性抗原和α-甲酰辅酶A消旋酶水平对前列腺癌根治术后患者预后的预测价值[J].新乡医学院学报,2023,40(11):1056-1060.[doi:10.7683/xxyxyxb.2023.11.009]
　GUO Xiaoxiang,ZHU Haisong,ZHANG Chao,et al.Prognostic value of serum prostate specific antigen and alpha-methylacyl coenzyme A racemase for prognosis of prostate cancer patients after radical prostatectomy[J].Journal of Xinxiang Medical University,2023,40(11):1056-1060.[doi:10.7683/xxyxyxb.2023.11.009]
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血清前列腺特异性抗原和α-甲酰辅酶A消旋酶水平对前列腺癌根治术后患者预后的预测价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年11
页码:
1056-1060
栏目:
临床研究
出版日期:
2023-11-05

文章信息/Info

Title:
Prognostic value of serum prostate specific antigen and alpha-methylacyl coenzyme A racemase for prognosis of prostate cancer patients after radical prostatectomy
作者:
郭晓翔; 朱海松; 张超; 刘起
（驻马店市中心医院泌尿外一科，河南　驻马店　463000）
Author(s):
GUO Xiaoxiang; ZHU Haisong; ZHANG Chao; LIU Qi
(No 1.Department of Urology,Zhumadian Central Hospital,Zhumadian 463000,Henan Province,China)
关键词:
前列腺特异性抗原; α-甲酰辅酶A消旋酶; 前列腺癌根治术; 预后
Keywords:
prostate specific antigen; alpha-methylacyl coenzyme A racemase; radical prostatectomy; prognosis
分类号:
R737.25
DOI:
10.7683/xxyxyxb.2023.11.009
文献标志码:
A
摘要:
目的　探讨血清前列腺特异性抗原（PSA）、α-甲酰辅酶A消旋酶（AMACR）水平在前列腺癌根治术前后的变化及其对预后的预测价值。
方法　选择2017年1月至2020年1月驻马店市中心医院收治的128例前列腺癌患者为研究对象。患者均行前列腺癌根治术治疗，根据其预后情况分为预后良好组（n=97）和预后不良组（n=31）。收集患者的年龄、体质量指数（BMI）、肿瘤最大径、前列腺体积、病理类型、淋巴结转移、远处转移、TNM分期、分化程度、Gleason评分、切缘等基本资料。分别于术前及术后7 d，抽取患者空腹静脉血5 mL，1 500 r·min-1离心10 min，留取血清，采用酶联免疫吸附法测定血清PSA、AMACR水平。比较患者手术前后的血清PSA、AMACR水平，采用单因素分析影响前列腺癌根治术后患者预后的相关因素，logistic回归分析影响前列腺癌根治术后患者预后的危险因素，受试者操作特征（ROC）曲线分析血清PSA、AMACR水平对前列腺癌根治术后患者预后不良的预测价值。
结果　前列腺癌患者根治术后的血清PSA、AMACR水平显著低于术前（P<0.05）。预后不良组与预后良好组患者的年龄、BMI、肿瘤最大径、前列腺体积、病理类型比较差异无统计学意义（P>0.05）；预后不良组患者TNM分期Ⅲ~Ⅳ期占比、淋巴结转移占比、低分化占比、Gleason评分≥7分占比、切缘阳性占比及术前血清PSA、AMACR水平显著高于预后良好组（P<0.05）；logistic分析结果显示，TNM分期Ⅲ~Ⅳ期、淋巴结转移、低分化程度、高Gleason评分、切缘阳性及高血清PSA、AMACR水平是影响前列腺癌根治术后患者预后不良的危险因素（P<0.05）；ROC曲线分析显示，血清PSA、AMACR水平预测前列腺癌根治术后患者预后不良的曲线下面积（AUC）分别为0.796、0.824，二者联合预测前列腺癌根治术后患者预后不良的AUC为0.916；血清PSA与AMACR水平联合预测前列腺癌根治术后患者预后不良的AUC显著大于血清PSA和AMACR水平单独预测（P<0.05）。
结论　血清PSA、AMACR水平异常升高是前列腺癌根治术后患者预后不良的危险因素，二者联合检测对前列腺癌根治术后患者预后不良有较高的预测价值。
Abstract:
Objective　To investigate the changes of serum prostate specific antigen (PSA) and alpha-methylacyl coenzyme A racemase (AMACR) levels of patients with prostate cancer before and after radical prostatectomy and their prognostic value for prognosis.
Methods　A total of 128 patients with prostate cancer admitted to Zhumadian Central Hospital from January 2017 to January 2020 were selected as the study objects.All patients underwent radical resection of prostate cancer,and they were divided into good prognosis group (n=97) and poor prognosis group (n=31) according to their prognosis.The patients′ age,body mass index (BMI),maximum tumor diameter,prostate volume,pathological type,lymph node metastasis,distant metastasis,TNM stage,differentiation degree,Gleason score,incisal margin and other basic data were collected.Before surgery and 7 days after surgery,5 mL of fasting venous blood was extracted from the patients,1 500 r·min-1 was centrifuged for 10 min,and serum was retained.The serum PSA and AMACR levels were determined by enzyme-linked immunosorbent assay.The serum PSA and AMACR levels of patients before and after surgery were compared,and the relevant factors affecting the prognosis of patients with prostate cancer after radical prostatectomy were analyzed by single factor analysis,and the risk factors affecting the prognosis of patients with prostate cancer after radical prostatectomy were analyzed by logistic regression analysis.The predictive values of serum PSA and AMACR levels for poor prognosis of patients with prostate cancer after radical prostatectomy were analyzed by receiver operating characteristic (ROC) curve.
Results　The levels of serum PSA and AMACR of patients with prostate cancer after radical prostatectomy were significantly lower than those before operation(P<0.05).There was no significant difference in age,BMI,maximum tumor diameter,prostate volume and pathological type between the poor prognosis group and the good prognosis group(P>0.05).The proportion of TNM stage Ⅲ-Ⅳ,the proportion of lymph node metastasis,the proportion of low differentiation,the proportion of Gleason score ≥7,the proportion of incisal margin positive and the preoperative serum PSA and AMACR levels in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05).Logistic analysis showed that TNM stage Ⅲ-Ⅳ,lymph node metastasis,low degree of differentiation,high Gleason score,incisal margin positive and high serum PSA and AMACR levels were risk factors for poor prognosis of prostate cancer patients after radical prostatectomy (P<0.05).ROC analysis showed that the area under the curve (AUC) of serum PSA and AMACR in predicting poor prognosis of patients with prostate cancer after radical prostatectomy was 0.796 and 0.824,respectively;and the AUC of combined PSA and AMACR in predicting poor prognosis of patients with prostate cancer after radical prostatectomy was 0.916.The AUC of combination of serum PSA and AMACR levels in predicting poor prognosis of patients with prostate cancer after radical prostatectomy was significantly greater than that of the serum PSA and AMACR alone (P<0.05).
Conclusion　Abnormal increase of serum PSA and AMACR levels is a risk factor for poor prognosis of patients with prostate cancer after radical prostatectomy.The combined detection of serum PSA and AMACR levels has a high predictive value for the poor prognosis of patients with prostate cancer after radical prostatectomy.

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更新日期/Last Update: 2023-11-05