ADT辅助治疗Gleason高危患者术前后PSA相关性分析

罗宇成; 吴迪; 王振楠; 杨雷; 汤召兵

doi:10.13406/j.cnki.cyxb.004063

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ADT辅助治疗Gleason高危患者术前后PSA相关性分析

临床研究 | 更新时间：2026-04-15

- ADT辅助治疗Gleason高危患者术前后PSA相关性分析
- Correlation between the preoperative and postoperative levels of prostate-specific antigen in patients with high-risk Gleason scores undergoing adjuvant androgen deprivation therapy
- 重庆医科大学学报 2026年51卷第4期页码：581-586
- 作者机构：
  
  重庆医科大学附属第一医院泌尿外科，重庆 400016
- 作者简介：
  
  罗宇成，Email：857128412@qq.com，研究方向：泌尿外科。
  汤召兵，Email：tangzhaobing1127@163.com。
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004063
  中图分类号： R737.25
- 收稿：2026-01-04，
  
  修回：2026-02-10，
  
  录用：2026-02-28，
  
  纸质出版：2026-04-28
- 稿件说明：
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罗宇成，吴迪，王振楠，等.ADT辅助治疗Gleason高危患者术前后PSA相关性分析[J].重庆医科大学学报，2026，51（4）：581-586.

Luo Yucheng,Wu Di,Wang Zhennan,et al.Correlation between the preoperative and postoperative levels of prostate-specific antigen in patients with high-risk Gleason scores undergoing adjuvant androgen deprivation therapy[J].Journal of Chongqing Medical University,2026,51(4):581-586.
罗宇成，吴迪，王振楠，等.ADT辅助治疗Gleason高危患者术前后PSA相关性分析[J].重庆医科大学学报，2026，51（4）：581-586. DOI： 10.13406/j.cnki.cyxb.004063.

Luo Yucheng,Wu Di,Wang Zhennan,et al.Correlation between the preoperative and postoperative levels of prostate-specific antigen in patients with high-risk Gleason scores undergoing adjuvant androgen deprivation therapy[J].Journal of Chongqing Medical University,2026,51(4):581-586. DOI： 10.13406/j.cnki.cyxb.004063.

摘要

目的

探讨Gleason高危评分前列腺癌患者根治术后辅助雄激素剥夺治疗（androgen deprivation therapy，ADT）总前列腺特异性抗原（total prostate-specific antigen，TPSA，以下称PSA）变化情况与术前PSA的相关性，并构建风险预测模型，为临床治疗提供参考。

方法

收集重庆医科大学附属第一医院2020年至2023年行前列腺癌根治术且符合以下条件的Gleason高危评分患者142例：未接受新辅助治疗、术后Gleason评分≥4+3分、术后分期≤T2cN0M0、标本切缘无癌累及、规律行ADT治疗、术后PSA谷值

0.2 ng/mL等条件的共142例Gleason高危评分患者。通过Rsoftware4.0.1软件进行数据处理，采用单因素COX回归分析术前PSA与术后PSA异常升高的相关性，以不同PSA分界值绘制卡普兰-迈耶（Kaplan-Meier，KM）曲线，Log-rank检验分析组间差异，检验水准

=0.05。

结果

142例患者中，术后2年内出现PSA异常升高60例（42.25%），未出现异常升高82例（57.75%）。COX回归分析显示，术前PSA与术后PSA异常升高明显相关：以20 ng/mL为分界点时，风险比（hazard rat

io，HR）为1.670［95%置信区间（confidence interval，CI）=1.006~2.774，

=0.047］；以中位数17.755 ng/mL为分界点时，HR为2.034（95%CI=1.202~3.442，

=0.008）；三分组（

10、10~20、

20 ng/mL）中，

20 ng/mL组HR为2.176（95%CI=1.082~4.506，

=0.030），而10~20 ng/mL组差异无统计学意义（

=0.235）。KM曲线显示，单一PSA分界值下各组累计无PSA异常升高比例差异有统计学意义，多分界点曲线预测趋势更明显，但其组间统计学差异有限。

结论

术前PSA水平是Gleason高危前列腺癌患者根治术后2年内PSA异常升高的有效预测指标。其中，以术前PSA中位数（17.755 ng/mL）为分界点的预测效能最优，明显优于传统20 ng/mL界值；三分组分析显示10~20 ng/mL区间为术后PSA异常升高的风险过渡区间，单一PSA指标难以有效分层。多分界点虽能更细致呈现风险梯度、提升早期趋势预测价值，但受样本量限制未形成明显统计学分层。临床实践中，结合术前前列腺增强磁共振成像（magnetic resonance imaging，MRI）、病理分级等多模态指标可进一步优化风险评估精度，为新辅助治疗决策、个性化随访频率制定及早期方案调整提供关键参考，尤其对术前PSA高于中位数的高风险人群，应强化术后2年内的随访与干预。

Abstract

Objective

To investigate the change in prostate-specific antigen（PSA） after surgery and its correlation with preoperative PSA level in prostate cancer patients with high-risk Gleason scores undergoing adjuvant androgen deprivation therapy（ADT） after radical prostatectomy，to establish a risk prediction model，and to provide a reference for clinical treatment.

Methods

Clinical data were collected from 142 patients with high-risk Gleason scores who underwent radical prostatectomy in The First Affiliated Hospital of Chongqing Medical University from 2020 to 2023 and met the criteria of not receiving neoadjuvant therapy，a postoperative Gleason score of ≥4+3，a postoperative stage of ≤T2cN0M0，absence of cancer involvement at the surgical margins，regular postoperative ADT sessions，and a valley value of

0.2 ng/mL for PSA after surgery. R software 4.0.1 was used for data processing，and a univariate

Cox

regression analysis was used to assess the correlation between preoperative PSA and the abnormal increase in PSA after surgery. The Kaplan-Meier （KM） curves were plotted based on the different cut-off values of PSA，and the log-rank test was used f

or comparison between groups at a significance level of α=0.05.

Results

Among the 142 patients，60（42.25%） had an abnormal increase in PSA within 2 years after surgery，and 82（57.75%） did not experience the abnormal increase in PSA. The

Cox

regression analysis showed that preoperative PSA was significantly correlated with the abnormal increase in PSA after surgery，with a hazard ratio（

） of 1.670（95%CI=1.006-2.774，

=0.047） at the cut-off value of 20 ng/mL and an

value of 2.034 （95%CI=1.202-3.442，

=0.008） at the cut-off value of 17.755 ng/mL（the median value），and the analysis of the three groups（

10，10-20，and

20 ng/mL） showed that the

20 ng/mL group had an

value of 2.176（95%CI=1.082-4.506，

=0.030），while the 10-20 ng/mL group showed no significant difference（

=0.235）. The KM curve analysis showed that there was a significant difference in the cumulative proportion of patients without abnormal increase in PSA between groups under a single cut-off value of PSA；although the multi-cutoff curves had a more significant predictive trend，they showed a limited statistical difference between groups.

Conclusion

Preoperative PSA level is an effective predictive indicator for abnormal increase in PSA within 2 years after radical prostatectomy in patients with high-risk prostate cancer based on Gleason score. The median value of PSA before surgery （17.755 ng/mL） has the best predictive efficacy as the cut-off value and is significantly superior to the traditional cut-off value of 20 ng/mL. The analysis of the three groups shows that the 10-20 ng/mL range is a risk transition interval for abnormal increase in PSA after surgery，and a single PSA indicator fails to achieve effective stratification. Although multi-cutoff values can present the risk gradient in greater detail and improve the value of early trend prediction，no significant statistical stratification has been formed due to the limited sample size. In clinical practice，combining multi-modal indicators such as preoperative contrast-enhanced prostate MRI and pathological grading can further enhance the accuracy of risk assessment，thereby providing key references for decision making associated with neoadjuvant therapy，formulation of individualized follow-up frequency，and adjustments of early treatment regimens. Follow-up and intervention within 2 years after surgery should be strengthened for high-risk populations with preoperative PSA higher than the median.

关键词

Keywords

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