| Research BackgroundProstate cancer is one of the most common carcinoma in males in China,and the incidence of prostate cancer has increased rapidly recently.After the occurrence of bone metastasis in patients with prostate cancer,the means of treatment is limited,and the overall survival rate is significantly reduced.Early prediction of bone metastasis in patients with prostate cancer is beneficial to the treatment and prognosis of patients.Whole body bone scan has been routinely used to diagnose bone metastasis in China,but its specificity is poor,and not all patients with newly diagnosed prostate cancer have a high risk of bone metastasis.routine bone scan will increase patients’unnecessary radiation exposure and high medical expenses.Therefore,how to screen patients who need bone scan has a certain research value.Tumor microloop,including immune inflammation,coagulation-hemostasis,nutrition-metabolism and other related indicators,is remarkably significant in the appearance and progression of carcinoma.Some studies have indicated that tumor microenvironment-related peripheral blood indexes can predict the progression and prognosis of many kinds of malignant tumors.In this study,combined with the traditional predictors of bone metastasis of prostate cancer,the predictive value of tumor microenvironment-related peripheral blood indexes such as immune inflammation,coagulation-hemostasis and nutritionmetabolism on the risk of bone metastasis of prostate cancer was retrospectively analyzed.ObjectiveThe purpose of this study is to retrospectively analyze the value of tumor microenvironment-related peripheral blood indexes in predicting the risk of bone metastasis in patients with newly diagnosed prostate cancer by combining the traditional clinical indicators related to bone metastasis of prostate cancer recommended by Chinese guidelines.To explore new economical and harmless predictors of bone metastasis in patients with newly diagnosed prostate cancer and to provide some guidance for clinical work.MethodsThe clinical statistics of patients with prostate cancer diagnosed for the first time in the department of urology of our hospital from January 2016 to December 2019 were retrospectively analyzed,including general data,tumor clinical T stage,total prostate specific antigen(tPSA);Gleason score,prostate specific antigen density(PSAD);alkaline phosphatase serum calcium and phosphorus,peripheral blood immune inflammation index,coagulation index,nutrition-metabolism index.Comprehensive peripheral blood indexes:platelet to lymphocyte count ratio(PLR),neutrophil to lymphocyte count ratio(NLR),systemic immune inflammation index(SII),albumin to globulin ratio(AGR),nutrition index(PNI).Patients with newly diagnosed prostate cancer were divided into two groups:bone metastasis group and non-metastasis group.SPSS26.0 statistical software was used for analysis,and the measurement data were expressed by x±s or M(P25-P75).Independent sample t-test was used to compare normal distribution data between groups,and Matney U test was used to compare skewness distribution data.The counting data were compared by χ2 test.Logistic regression analysis was used to analyze the influencing factors of bone metastasis of prostate cancer.The diagnostic value of comprehensive peripheral blood indexes was evaluated and the cutoff value was determined by the method of receiver working characteristic curve.The difference was statistically significant(P<0.05).ResultsA total of 332 patients with prostate cancer were eligible and included in the study:118 cases(35.5%)in the bone metastasis group and 214 cases(64.5%)in the nonmetastasis group.There were significant differences in clinical T stage,Gleason score,tPSA,PSAD,phosphorus,ALP,nutritional metabolism index(albumin,hemoglobin),coagulation index(platelet,fibrinogen,D-dimer),comprehensive index(NLR,SII,AGR,PNI)between the two groups.There was no significant difference in age,serum calcium,inflammatory indexes(neutrophils,lymphocytes)and PLR.The results of univariate analysis showed that clinical T stage,Gleason score,tPSA,PSAD,ALP,nutritional and metabolic indexes(albumin,hemoglobin),coagulation indexes(platelet,fibrinogen,D-dimer)and comprehensive indexes(SII,AGR,PNI)were related to bone metastasis of prostate cancer(P<0.05).The results of multivariate correlation analysis showed that only T stage,Gleason score,tPSA,ALP and D-dimer were independently associated with bone metastasis of prostate cancer(P<0.05).Combined with independent forecasting factors,a comprehensive forecasting model is constructed,the ROC curves of independent forecasting factors and comprehensive forecasting model are drawn,and the best cut-off value is calculated.The area under the curve of the comprehensive predictive model for predicting bone metastasis in newly diagnosed prostate cancer patients was 0.937(AUC=0.937,95%CI:0.918-0.966),which was significantly better than that of D-dimer(0.800),clinical T stage(0.762),GS(0.694),tPSA(0.839)and ALP(0.830).Conclusion1.In this study,it was found that the level of serum D-dimer was an independent predictor of bone metastasis in patients with newly diagnosed prostate cancer;2.In addition,D-dimer can be combined with traditional predictors such as GS,tPSA,clinical T stage and ALP to evaluate the possibility of bone metastasis in patients with newly diagnosed prostate cancer:when D-dimer>0.19mg/L,clinical T stage>3,GS>7,tPSA>82.06ng/mL,ALP>85.5U/L,the possibility of bone metastasis should be highly suspected and further diagnosed and treated;3.There was a good correlation between tumor microenvironment-related peripheral blood indexes and bone metastasis of prostate cancer.Nutritional and metabolic indexes(albumin,hemoglobin),coagulation indexes(platelet,fibrinogen,Ddimer),comprehensive indexes(systemic immune inflammation index(SII),albuminglobulin ratio(AGR),prognostic nutrition index(PNI)were risk factors for bone metastasis of prostate cancer.As a convenient and economical clinical index,it should be paid more attention to. |
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