fPSAtPSA比值优化前列腺癌早期诊断作用的研究

108Vol.10No.820048NationalJournalofAndrologyAug.2004fPSA/tPSA1,1,1,1,1,1,2,3,1(1.,130021;2.,110000;3.,y{981)::/(fPSA/tPSA)tPSA(PCa):50PCatPSA4.020.0g/L187,tPSAfPSA,SPSS10.0fPSA/tPSA:tPSA4.010.0g/L10.020.0g/L,PCa18.1%22.5%ROCfPSA/tPSA(AUC)tPSA(P0.05)fPSA/tPSA0.25,tPSA4.010.0g/L10.020.0g/LPCa90.5%87.5%,26.7%11.3%:,fPSA/tPSAtPSA4.020.0g/LPCa,:;;/:R737.25;R446.62:A:100923591(2004)0820582204EarlyDiagnosisofProstateCancerUsingFree/TotalProstate2SpecificAntigenRatiowithPopulation2BasedScreeningDataZhangLing,JiGuoyi,LiXiaomeng,WangWeihua,GaoHongwen,PanYuzhuo,WangHongjun,KuwaharaMasaaki,ZhaoXuejianResearchCenterofProstateDiseasePreventionandTreatment,JilinUniversity,Changchun,Jilin130021,China(ZhangL,JiGY,LiXM,WangWH,GaoHW,PanYZ,ZhaoXJ);ResearchInstituteofMilitaryMedicine,ShenyangCommand,Shenyang,Liaoning110000,China(WangHJ);DivisionofUrology,MiyagiCancerCenter,Natorit981,Japan(MasaakiK)Correspondenceto:ZhaoXuejian,E2mail:[e-mail]:Objective:Toevaluatetheuseoffree/totalprostate2specificantigenratio(fPSA/tPSAratio)inimprovingtheearlydiagnosisofprostatecancer.Methods:fPSA/tPSAratiointheserumwasanalyzedprospectivelyin187menwithtPSArangingbetween4.0and20.0g/L.Allofthemunderwentultrasound2guidedsextantprostaticbiopsies.Sensitivity,specificity,positiveandnegativepredictivevalueswerecalculatedbySPSS10.0software.Results:Prostatecancerdetectionrateswere18.1%and22.5%whentPSAwaswithintherangesof4.010.0g/Land10.020.0g/Lrespectively.fPSA/tPSAratiowasmoresignificantthantPSAinallthemen.Whenthecut2offvalueoffPSA/tPSAratiowassetat0.25,90.5%and87.5%ofcancerscouldbedetected;and26.7%and11.3%ofbiopsiescouldbeavoidedwithinthetPSArangesof4.010.0g/Land10.020.0g/L,respectively.Conclusion:TheuseoffPSA/tPSAratiocanimprove285:2003212215;:2004205220:(59):(19762),,,,E2mail:[e-mail]:,E2mail:[e-mail]©1995-2004TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.prostatecancerdetectionandreduceunnecessarybiopsieswhentPSAiswithintherangeof4.010.0g/Land10.020.0g/L.NatlJAndrol,2004,10(8):5822585Keywords:prostatecancer;prostate2specificantigen;free/totalPSAratio(tPSA)(PCa)tPSA4.010.0g/LPCa25.4%,10.020.0g/L37.7%[1],tPSA,PSA(fPSA)/tPSAPCa(BPH),tPSA4.010.0g/LPCa[24]PCafPSA/tPSA,tPSA,,PCa,11.11998420034tPSA1371450PCa,tPSA(tPSA4.0g/L)7.9%tPSA4.020.0g/L187,PCa37(19.8%),5482(69.196.89);(PCa)150(80.2%),5083(68.507.78),BPH124,(PIN)6,13,71.2,-20CanAgtPSAfPSA,TandemRPSA,(r=0.958,P0.001),1.3PearsontROC(receiveroperatechar2acteristics)fPSA/tPSAtPSA,(areaundercurves,AUC)McNemarSPSS10.022.1tPSAfPSA/tPSA1,PCaPCatPSA(P0.05);PCafPSA/tPSAPCa(P0.01)tPSAfPSA/tPSA2,tPSA4.010.0g/L,PCa18.1%;tPSAp10.020.0g/L22.5%fPSA/tPSA11PCaPCatPSAfPSA/tPSA(xs)Table1.Comparisonofage,tPSAandfPSA/tPSAratiosinpatientswithandwithoutprostatecancer(xs)Noncancer(n=150)Cancer(n=37)PAge(years)68.507.78(5083)69.196.89(5482)0.071tPSA(g/L)8.653.33(4.0218.40)9.794.66(4.0319.40)0.162fPSA(g/L)1.600.99(0.105.39)1.220.94(0.055.27)0.036fPSA/tPSAratio0.190.11(0.020.70)0.130.07(0.010.30)0.0012.2fPSA/tPSAtPSAPCa2tPSAfPSA/tPSAtPSAROC,tPSA4.010.0g/L,fPSA/tPSAAUC0.691,tPSAAUC0.505(P0.01)tPSA10.020.0g/L,fPSA/tPSAAUC0.669,tPSAAUC0.595(P0.05)2.3fPSA/tPSAPCa3tPSAfPSA/tPSAPCa0.15fP2SA/tPSA,tPSA4.010.0g/L57.1%63.8%51.7%;10.0tPSA20.0g/L62.5%45.5%35.2%3858fPSA/tPSA©1995-2004TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.2tPSAfPSA/tPSA(n)Table2.PathologicaldiagnosisofbiopsiedspecimenswithinvariousrangesoftPSAandfPSA/tPSAratio(n)fPSA/tPSAtPSA4.010.0g/LBPHPCaPINAtypicalglandGranulomatousprostatitisTotal10.0tPSA20.0g/LBPHPCaPINAtypicalglandGranulomatousprostatitisTotal0.152511154462610101380.1741011763010100.193500083000030.217001085000050.235200070100010.256001074001050.286000062201160.281922002733total752151051164916132711tPSA4.020.0g/LtPSAfPSA/tPSAFigure1.DistributionofPCaandBPHpatientsaccordingtotPSA,fPSA/tPSAratiosandthebiopsyresultswithinthetPSArangeof4.020.0g/L3PCa,3min1PCa[5],PCa[68\tPSA,,17%24%[9],tPSA4.010.0g/L,75%[5]1999PCa,50PCa25.3%[8],74.7%;tPSA4.010.0g/L10.0tPSA20.0g/L,PCa18.1%22.5%,2tPSAfPSA/tPSAtPSAROCFigure2.Receiveroperatingcharacteristic(ROC)curvesforanalyzingthediagnosticvalueoftPSAandfPSA/tPSAratiosaccordingtotPSAranges4852004810©1995-2004TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.3tPSAfPSA/tPSAPCa(%)Table3.Sensitivity,specificity,positivepredictivevalues(PPV),andnegativepredictivevalues(NPV)ofthepatientswithbiopsyavoidedus2ingfPSA/tPSAratio(%)fPSA/tPSAtPSA4.010.0g/LSensitivitySpecificityPPVNPVBiopsyavoided10.1tPSA20.0(g/L)SensitivitySpecificityPPVNPVBiopsyavoided0.1557.163.826.185.751.762.545.525.080.635.20.1766.757.424.585.746.681.338.227.793.932.40.1971.455.329.592.744.087.532.727.590.025.40.2181.042.626.191.537.187.525.525.587.519.70.2385.740.426.395.032.887.520.024.184.615.50.2590.531.924.193.926.787.514.523.080.011.30.2895.224.522.592.621.61007.332.91005.6tPSA,fPSA/tPSAtPSA1993,Christensson[10]fPSA/tPSAPCaBPH144BPH121PCa,BPHfPSA/tPSA0.28;PCa0.18,(P0.001),tPSA10.0g/L,fPSA/tPSA0.18,tPSA55%73%,(90%)Catalona[9],tPSA2.510.0g/LfPSA/tPSA