根治性前列腺切除术后 Gleason 评分升级相关因素分析

Analysis of factors associated with Gleason score upgrading after radical prostatectomy

摘要

目的 分析根治性前列腺切除术 (RP) 术后 Gleason 评分升级 (GSU) 的影响因素, 为临床精准评估疾病分级提供依据。方法 回顾性纳入 2019 年 1 月—2025 年 1 月吉林省人民医院行 RP 的 68 例前列腺癌患者作为研究对象, 依据术后 Gleason 评分 (GS) 是否较穿刺活检评分升级, 分为升级组 (38 例) 和非升级组 (30 例)。通过单因素分析筛选出差异有统计学意义 (P<0.05) 的指标, 并将其纳入多因素 logistic 回归模型分析患者 RP 术后 GSU 的影响因素。结果 升级组前列腺特异性抗原 (PSA) 及 PSA 密度高于非升级组 (P<0.05), 而前列腺体积 (PV) 及穿刺 GS 低于非升级组 (P<0.05)。高 PSA (OR = 1.129, 95%CI: 1.023~1.246, P= 0.016)、低 PV (OR = 0.877, 95%CI: 0.877 ~ 0.979, P = 0.007) 及低穿刺 GS (OR = 0.426, 95%CI: 0.218 ~ 0.835, P = 0.013) 是术后 GSU 的独立危险因素。结论 术前 PSA 水平、PV 及穿刺 GS 可作为预测 RP 术后 GSU 的关键指标, 有助于优化临床风险分层决策。

Abstract

Objective This study aimed to analyze the influencing factors of Gleason score upgrading (GSU) after radical prostatectomy (RP), so as to provide a basis for accurate clinical assessment of disease grading. Methods Rrospective analysis was conducted on 68 prostate cancer patients who underwent RP at Jilin Provincial People's Hospital between January 2019 and January 2025. Based on whether the postoperative Gleason score (GS) showed upgrading compared with the biopsy GS, the patients were divided into an upgrading group (n = 38) and a non-upgrading group (n = 30). Variables showing statistically significant differences (P<0.05) in univariate analysis were subsequently included in a multivariate logistic regression model to identify factors influencing post-RP Gleason score upgrading. Results The GSU cohort exhibited significantly elevated prostate-specific antigen (PSA) (P<0.05) and PSA density (P<0.05), alongside reduced prostate volume (PV) (P<0.05) and lower biopsy GS (P<0.05) versus the non-GSU cohort. Elevated PSA (OR = 1.129, 95% CI: 1.023-1.246, P = 0.016), reduced PV (OR = 0.877, 95% CI: 0.877-0.979, P= 0.007), and lower biopsy GS (OR= 0.426, 95%CI: 0.218-0.835, P= 0.013) were independent risk factors for postoperative GSU. Conclusion Preoperative PSA, PV, and biopsy GS serve as critical predictors of GSU following RP, enabling refined clinical decision-making for risk stratification.

关键词

前列腺癌 / 前列腺切除 / Gleason 评分升级 / 前列腺活检 / 影响因素

Key words

Prostate cancer / Radical prostatectomy / Gleason score upgrading / Prostate biopsy / Influencing factors

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