The Potential Value Of High Sensitive C-reactibe Protein And The Ratio Of Fibrinogen To Prealbumin In The Diagnosis And Prognosis Of Prostate Cancer

Background:At present,prostate specific antigen(PSA)is the only non-invasive biomarker used to detect and evaluate the therapeutic effect of prostate cancer(PCa),but it is not sensitive to the diagnosis of PCa and the prediction of tumor invasion,and the diagnosis of prostate cancer by serum PSA alone leads to over diagnosis or over treatment.The purpose of this study is to explore the relationship between the high sensitive CRP(Hs-CRP)and fibrinogen/prealbumin(FPR),the occurrence of PCa,the prognosis of surgical survival and the clinicopathological characteristics,in order to obtain the laboratory indexes that can provide effective prediction in the diagnosis and the pre and post aspects of PCa,in addition to PSA.Methods:1.In the PCa diagnosis prediction study,we selected the data of 135 patients with prostate cancer,106 patients with prostate hyperplasia and 90 healthy middle-aged and old men who were admitted to the urology department of the First Affiliated Hospital of Suzhou University from August 2012 to December 2015.Firstly,we screened out the significant indexes for PCA diagnosis,and further evaluated the efficacy of Hs-CRP,FPR and their combined indexes in the differential diagnosis of prostate cancer and benign prostatic hyperplasia(BPH),and calculated the cutoff value,sensitivity and specificity of related indexes through ROC curve.2.In the study of PCa prognosis prediction,we analyzed the age,Gleason score,tumor pathological stage,depth of tumor invasion,operation mode,Hs-CRP,FPR value of peripheral blood and other clinicopathological data of PCa patients included in the study The risk prediction model was used to analyze single factor and multiple factors to find out various factors that affect the postoperative survival rate of prostate cancer patients.The ROC curve of the relationship between Hs-CRP,FPR value and prognosis was used to determine the best cut-off value of Hs-CRP and FPR.The patients were divided into Hs-CRP,high FPR and low FPR groups based on the best dividing point.The difference of total survival period and clinicopathological data of patients in different groups were compared Different.Results:On the one hand,in the application of Hs-CRP and FPR in the diagnosis of PCa:(1)Hs-CRP and FPR in PCa group were significantly higher than those in BPH group and normal control group(P<0.05);(2)univariate and multivariable logistic regression analysis suggested that Hs-CRP and FPR There was a certain correlation between FPR and the differential diagnosis of PCa and BPH,but only FPR could be used as an independent risk predictor for the differential diagnosis of PCa and BPH(P<0.05).The higher the FPR,the higher the risk of prostate cancer.(3)ROC curves of Hs-CRP,FPR and Hs-CRP+FPR were analyzed and compared,give the result as follows:For Hs-CRP,the area under the curve(AUC)was 0.622,the cutoff value was 0.64,the sensitivity(SEN)was 71%,the specificity(SPE)was 49%,the positive predictive value(PPV)was 61%,the negative predictive value(NPV)was 50%;For FPR,the auc was 0.666,the cutoff value was 10.08,the sen was 69%,the spe was 58%,the ppv was 65%,and the npv was 54%;For Hs-CRP+FPR,The auc was 0.675,the cutoff value was 11.35,the sen was 65%,the spe was 52%,the ppv was 69%,and the npv was 58%.The correlation area has reached the target level with predictive value.(4)The cut-off value of FPR was 10.08.The patients were divided into high FPR group and low FPR group.There was a significant difference in the incidence of prostate cancer between the two groups(P<0.05).The probability of prostate cancer was higher in high FPR group.On the other hand,when predicting the postoperative survival of all patients in PCa group with Hs-CRP,FPR and relevant clinicopathological data,we found that Hs-CRP,FPR,Gleason score,tumor pathological stage and tumor invasion depth were one of the factors influencing the postoperative survival of PCa patients Cox multivariate analysis indicated that Hs-CRP?1.94mg/L,FPR?14.79 and tumor pathological stage?stage ? were independent risk factors for total survival of PCa patients.Furthermore,the cut off values of Hs-CRP and FPR predicted by ROC curve were 1.94mg/L and 14.79.PCa patients were divided into Hs-CRP high and low group and FPR high and low group.Chi square test showed that there were statistically significant differences in tumor invasion depth,Gleason score and tumor pathological stage between the two groups(P<0.05).At the same time,we drew the survival curve according to Kaplan Meier,and tested it with log rank method.It was found that the survival rates of patients with high Hs-CRP,high FPR and tumor pathological stage?stage ? were significantly lower than those of patients with low Hs-CRP,low FPR and tumor pathological stage<stage ?(P<0.05).Conclusion:As a cheap and easily available inflammatory marker in clinic,Hs-CRP and FPR have a certain significance in distinguishing PCa from BPH.At the same time,Hs-CRP and FPR have a better predictive effect on the postoperative survival of PCa patients undergoing radical surgery,and may be helpful for the choice of treatment and possible prevention of anterior adenocarcinoma in the future.