| Objective Prostate cancer is one of the malignant tumors that threaten the health of men.It is the most common carcinoma in the industrialised world,and its mortality rate is the third.The early diagnosis of prostate cancer is very difficult.When prostate cancer develops to an advanced stage,it is prone to distant metastasis,of which bone metastasis is the most common.At present,The most common examination for bone metastasis is a bone scan.NCCN、EAU and AJCC guidelines modify the bone scanning indications many times to reduce unnecessary bone scanning.However,bone scan indications are based on European and American studies,and it remains uncertain whether they are suitable for all populations,especially the Chinese population.Therefore,this study analyzed the clinical data of patients with prostate cancer in our hospital,discussed the features of bone metastasis of prostate cancer and its predictive factors,provided reference for clinical practice.Methods From January 2010 to December 2017,340 patients with prostate cancer diagnosed in the second affiliated Hospital of Dalian Medical University were retrospectively analyzed.All patients underwent bone scan after admission.The difference of age,prostate specific antigen(PSA),Gleason score,prostate specific antigen density(PSAD),alkaline phosphatase(ALP),neutrophil lymphocyte ratio neutrophil-lymphocyte ratio(NLR)and clinical T stage was analyzed between bone metastasis group and non-bone metastasis group.The correlation between these parameters and bone metastasis was analyzed by single factor correlation analysis.Multivariate logistic regression analysis was used to determine independent predictive factors in these parameters.Receiver operating characteristics(ROC)curves were used to analyze the predictive value of independent predictors on bone metastasis.Results The average age of 340 patients with prostate cancer was 73 years(73 ± 9 years);median PSA of was 41.92 ng / ml(16.96-110.83 ng / ml);the number of Gleason score ≤6,7,and ≥8 points were 38 patients(11.2%),154 patients(45.3%),148 patients(43.5%);median PSAD was 0.98 ng /(ml · cm3)[(0.38-2.39)ng /(ml · cm3)];median NLR was 2.27(1.61-3.00);median ALP was 76.0U / L(61.0-105.0U / L);the number of clinical stage T1 was 42 cases(12.4%),and T2 stage was 190 cases(55.8%),and T3 stage was 59 cases(17.4 %),and T4 stage was 49 cases(14.4%).In 340 patients with prostate cancer,bone metastases were found in 139 patients(40.9%)based on bone scan results and 201 patients(59.1%)had no bone metastasis.There were 110 cases(79.1%)of spine metastasis,93 cases(66.9%)of pelvic metastases,79 cases(56.8%)of rib metastases,54 cases(38.9%)of limbs bone metastases,39 cases(28.1% 30 cases(21.6%),25 cases(18.0%)of scapular metastasis,10 cases(7.2%)and 7 cases(5.0%)of maxillofacial and clavicular metastases respectively.Of the patients with bone metastases,37 patients(26.6%)involved 1 area,and 35 patients(25.2%)affected 2 areas,and 21 patients(15.1%)affected 3 areas and 5 patients(3.6%)affected 4 areas,and 10 patients(7.2%)involved 5 regions,13 patients(10.1%)involved 6 regions,13(9.3%)affected 7 regions,and 3 patients(2.2%)affected 8 regions,and 1 patient(0.7%)involved nine regions.PSA,Gleason score,PSAD,ALP,clinical T staging in the two groups were statistically significant(P <0.001);univariate analysis showed that PSA,Gleason score,PSAD,clinical T staging,ALP were correlated with bone metastasis(P <0.001).Multivariate logistic regression analysis showed that PSA,Gleason score,clinical T stage and ALP were independent predictors of bone metastasis(P <0.05).ROC curve showed that the area under the curve(AUC)of PSA and ALP were 0.827 and 0.768 respectively,and the cutoff values were 48.3ng/m L and 92.0U/L respectively,and the sensitivities were 81.3% and 75.6%,and the specificity were 61.2% and 88.6%.Prostate cancer with PSA ≤10ng/ml or Gleason score ≤ 6 or clinical staging T1 has a very low probability of bone metastasis.Conclusion 1.Bone metastasis of prostate cancer is most common in spinal metastasis.2.PSA,Gleason score,clinical T stage and ALP are independent predictors of bone metastasis in prostate cancer.3.Prostate cancer patients with PSA≤10ng/ml and Gleason score ≤ 6 and clinical staging T1 may not require bone scanning. |
