术前白蛋白碱性磷酸酶比值对前列腺癌根治术后生化复发时间的影响

Predictive value of preoperative albumin-to-alkaline phosphatase ratio on biochemical recurrence after radical prostatectomy

关键词:  前列腺癌  白蛋白碱性磷酸酶比值  生化复发  预后

Key words:  prostate cancer  albumin-to-alkaline phosphatase ratio  biochemical recurrence  prognosis

摘要:

目的 探讨术前白蛋白碱性磷酸酶比值（AAPR）与前列腺癌（PCa）根治术后生化复发（BCR）的关系。方法 收集苏州大学附属第一医院2012年5月至2015年10月收治的137例PCa患者的临床资料，根据患者有无发生BCR分为发生BCR组及未发生BCR组，比较两组间年龄、体质指数（BMI）、前列腺特异性抗原（PSA）、AAPR、高血压、糖尿病、Gleason评分、病理分期、辅助内分泌治疗（AHT）、BCR及随访时间的差异，并对有统计学差异的因素进行分层分析。取AAPR的三分位点0.5、0.64分为低AAPR组、中AAPR组及高AAPR组。根据Gleason评分分为低分组（6分），中分组（7分）及高分组（8~10分），参照TNM分期分为低分期组（Ⅱ期），中分期组（Ⅲ期），高分期组（Ⅳ期）。通过多元Logistic分析筛选出发生BCR的独立危险因素。采用Kaplan-Meier法绘制生存曲线，比较低AAPR组、中AAPR组及高AAPR组间BCR的差异。结果 本研究随访时间8~93个月，中位时间55个月，137例患者中有45例发生BCR。发生BCR组与未发生BCR组间AAPR、Gleason评分、病理分期、AHT差异有统计学意义（P<0.05），且低AAPR组BCR发生率高于中AAPR组及高AAPR组（P<0.05），高分组BCR发生率高于中分组及低分组（P<0.05），高分期组BCR发生率高于中分期组及低分期组（P<0.05）。多因素Logistics回归分析结果显示，AAPR为BCR的独立危险因素（P<0.05）。AAPR与Gleason评分及病理分期无关（P>0.05）。生存曲线结果表明，高、中、低AAPR组患者PCa根治术后未发生BCR生存时间具有反向关系，即AAPR水平越高，BCR越延迟发生（P<0.05）。结论 AAPR与PCa根治术后BCR的发生有关，且与未发生BCR生存时间相关，随着AAPR的升高，BCR发生率下降，无BCR生存时间延长。

Abstract:

Objective To investigate the relationship between preoperative albumin-to-alkaline phosphatase ration (AAPR) and biochemical recurrence (BCR) after radical prostatectomy. Methods From May 2012 to October 2015, clinical data of 137 cases of prostate cancer (PCa) treated in the First Affiliated Hospital of Soochow University were retrospectively analyzed including age, body mass index (BMI), prostate specific antigen (PSA), AAPR, hypertension, diabetes mellitus, Gleason Score, TNM stage,adjuvant hormonal therapy (AHT), BCR and follow-up time,and the factors with statistical differences were further analyzed. The patients were divided into different groups according to AARP cut-off points of 0.5 and 0.64 (low AAPR group, medium AAPR group and high AAPR group), Gleason Score system (low score group, Gleason score=6; medium score group, Gleason score=7; and high score group, Gleason score ≥ 8),and TNM stage (low stage group, stage Ⅱ; medium stage group, stage Ⅲ; and high stage group, stage Ⅳ). Independent risk factors for BCR were screened by multifactor logistic analysis. Kaplan-Meier method was used to draw survival curve to compare the differences of BCR among low, medium and high AAPR groups.Results BCR occurred in 45 of 137 patients with a median follow-up of 55 months (8-93 months). There were statistically significant differences in AAPR, Gleason Score, TNM stage and AHT between the BCR group and the non-BCR group (P<0.05). The incidence of BCR in the low AAPR group was higher than that in the medium and high groups (P<0.05); the incidence of BCR in the high Gleason Score group was higher than that in the medium and low groups (P<0.05); and the incidence of BCR in the high TNM stage group was higher than that in medium and low groups (P<0.05). Multivariate logistic regression analysis showed that AAPR was an independent risk factor for BCR (P<0.05). There was no correlation between AAPR and Gleason score as well as TNM stage (P>0.05).Survival curve analysis revealed significant difference of BCR-fee survival time among low, medium and high AAPR groups after radical prostatectomy (P<0.05). Conclusions AAPR is related to BCR after radical prostatectomy as well as BCR-free survival time. In association with the increase of AAPR, the incidence of BCR decreases, and the BCR-free survival time increases.