Risk Factors Analysis And Establishment Of Risk Assessment Model For Newly Diagnosed Prostate Cancer With Bone Metastasis

Background: Prostate cancer is one of the malignant tumors that threaten the health of elderly men.Due to the lack of typical clinical manifestations at the early stage,most patients are already in the middle and advanced stages with distant metastases when diagnosed.PCa frequently metastasizes to bone,and more than three-quarters of patients would have bone metastases during their disease course,and even more patients will have bone metastases at the initial diagnosis.Currently,the technetium Tc 99 m methylene diphosphonate(Tc 99 m MDP)bone scan method is accepted as the standard and is the most frequently used examination to diagnosis bone metastasis in PCa.However,its specificity is not high.More and more scholars believe that the bone scan is over executed.Many foreign scholars have conducted many studies on the risk factors analysis of prostate cancer bone metastasis and the establishment of risk stratification prediction models,aiming to exclude unnecessary bone scans,but studies based on European and American populations may not be applicable to the Chinese people.Therefore,based on the clinical data of newly diagnosed prostate cancer patients in our hospital,this study determined the risk factors for prostate cancer bone metastasis and the extremely low risk group for bone metastases.Based on large-scale data,a nomogram for predicting the risk of bone metastasis was established.Methods: The clinical data of newly diagnosed prostate cancer patients in the Urology Department of Gansu Provincial People's Hospital from January 2014 to November 2019 were retrospectively analyzed.All patients underwent transrectal ultrasound prostate biopsy and were diagnosed with prostate adenocarcinoma.The differences in age,serum calcium,red blood cell distribution width,alkaline phosphatase,neutrophil lymph percentage,TPSA,FPSA,prostate volume,cTx,and Gleason score levels were evaluated between patients with bone metastasis and non-bone metastasis.Single factor logistic regression analysis of bone metastasis risk factors,multi-factor logistic regression analysis of different indicators to determine the independent risk factors of bone metastasis,draw ROC curve and calculate the area under the curve,analyze the predictive efficacy.In addition,we draw the nomogram of the bone metastasis prediction model based on clinical data,and draw a calibration chart to evaluate the prediction accuracy.Results: A total of 332 patients were included,including 151 patients with bone metastases and 181 patients with non-bone metastases.The t test results showed that there was no difference between the two groups in age and serum calcium level(p> 0.05).The Mann-Whitney rank sum test showed that TPSA,FPSA,neutrophil lymph percentage,alkaline phosphatase,Gleason score and cTx There is a significant difference(p <0.05).Univariate logistic regression analysis showed that TPSA,FPSA,prostate volume,Gleason score,alkaline phosphatase,and cTx were risk factors for bone metastasis.Multivariate logistic regression results showed that TPSA,Gleason score ?8,alkaline phosphatase and cT3-cT4 were independent risk factors for bone metastasis.The area under the curve(AUC)of TPSA was 0.956,the AUC of Gleason score was 0.769,the area of ALP was 0.850,and the AUC of cTx was 0.799,all of which had good predictive power.The consistency index of Nomogram is 0.97.The calibration chart shows that the predicted curve fits well with the 45 ° diagonal line represented by the actual value,indicating that the accuracy of the model is high.Conclusions:(1)TPSA,Gleason score ?8,cT3-cT4,alkaline phosphatase are independent risk factors for bone metastasis of prostate cancer;(2)Patients with newly diagnosed prostate cancer patients with T1-T2 stage,Gleason score ?7 and TPSA <20ng / ml have a very low incidence of bone metastasis.If surgery is not considered,routine bone scan may not be necessary;(3)The nomogram model based on the clinical data of patients with prostate cancer in our hospital has high prediction accuracy and wide clinical application prospects,which can help clinicians to accurately assess the risk of bone metastasis in newly diagnosed patients with prostate cancer.