The goal of this study was to investigate the clinical application of free/total prostate-specific antigen (F/T PSA) ratio, considering the new broad serum total PSA (T-PSA) “gray zone” of 2.0–25.0 ng ml−1 in differential diagnosis of prostate cancer (PCa) and benign prostate diseases (BPD) in men over 50 years in Western China. A total of 1655 patients were included, 528 with PCa and 1127 with BPD. Serum T-PSA, free PSA (F-PSA), and F/T PSA ratio were analyzed. Receiver operating characteristic curves were used to assess the efficiency of PSA and F/T PSA ratio. There were 47.4% of cancer patients with T-PSA of 2.0–25.0 ng ml−1. When T-PSA was 2.0–4.0 ng ml−1, 4.0–10.0 ng ml−1, and 10.0–25.0 ng ml−1, the area under the curve (AUC) of F/T PSA ratio was 0.749, 0.769, and 0.761, respectively. The best AUC of F/T PSA ratio was 0.811 when T-PSA was 2.0–25.0 ng ml−1, with a specificity of 0.732, a sensitivity of 0.788, and an optimal cutoff value of 15.5%. The AUC of F/T PSA ratio in different age groups (50–59 years, 60–69 years, 70–79 years, and ≥80 years) was 0.767, 0.806, 0.815, and 0.833, respectively, and the best sensitivity (0.857) and specificity (0.802) were observed in patients over 80 years. The T-PSA trend was in accordance with the Gleason score, tumor node metastasis (TNM) stage, and American Joint Committee on Cancer prognosis group. Therefore, the F/T PSA ratio can facilitate the differential diagnosis of PCa and BPD in the broad T-PSA “gray zone”. Serum T-PSA can be a Gleason score and prognostic indicator.

目的 探讨改良中性粒细胞CD64(nCD64)指数与传统nCD64指数鉴别诊断感染的临床应用效能差异.方法 纳入自身免疫性疾病(AID)患者32例、血液肿瘤患者32例、急诊发热患者59例及健康体检者41例.所有患者中确诊感染者76例,非感染者47例.采用流式细胞术检测外周血淋巴细胞、单核细胞和中性粒细胞的CD64荧光强度,计算改良nCD64指数和传统nCD64指数并比较两种指数对感染的鉴别诊断效能.结果 感染患者的改良nCD64指数和传统nCD64指数均显著高于非感染患者及健康体检者(均P<0.05);两种指数鉴别感染的AUC分别为0.782和0.770(均P<0.05),最佳临界值分别为1.00和4.74.传统指数仅在AID中具有较好的诊断效能(AUC=0.887,P<0.05),改良指数在三类患者中均有较好的诊断效能(AUC均>0.75,P<0.05).结论 两种nCD64指数对感染的鉴别诊断均有一定的临床价值,且二者在自身免疫性疾病中诊断价值最高,改良nCD64指数较传统nCD64指数在急诊发热患者和血液肿瘤中有更高的诊断效能.

Objective To explore the clinical value of absolute count of peripheral lymphocytes in monitoring immune status of cancer patients with surgery therapy, we retrospectively analyzed the absolute counts of peripheral T-lymphocytes subsets and NK cells before and after surgery in patients with colorectal cancer or esophageal cancer. Methods Retrospectively analyzed the absolute counts of T lymphocytes and NK cells and the correlation between lymphocytes counts and tumor progression or pathological staging as well as dynamic characteristics of lymphocyte counts during perioperation in 64 cases of colorectal cancer and 55 cases of esophageal cancer with surgery therapy. Results (1) In patients with colorectal cancer, CD3+T lymphocytes, CD3+ CD4+ T lymphocytes and CD3+CD8+ T lymphocytes counts gradually increased from stageⅠto stageⅣ, but only CD3+CD4+ T lymphocytes and CD3+CD8+T lymphocytes increased significantly (P 0.05); and the count of postoperative CD3+, CD3+CD4+, CD3+CD8+T lymphocytes gradually increased from stageⅠto stageⅢ (P 0.05). Patients with metastasis have more counts of T lymphocytes subsets and lower count of NK cells than that of patients without metastasis, and only CD3+CD8+T lymphocytes significantly increased (P<0.05). There was no association between peripheral T lymphocytes count and degree of tumor differentiation or tumor metastasis in patients with esophageal cancer. (4) Dynamic analysis of absolute counts of perioperative T lymphocyte subsets and NK cells showed that postoperative T lymphocytes and NK cells firstly strikingly decreased (P<0.05), then increased (P<0.05). Conclusions The correlation of peripheral T lymphocytes or NK cells count with TNM staging, degree of tumor differentiation as well as tumor metastasis was not the same between colorectal cancer and esophageal cancer. In patients with colorectal cancer the responsively increasing preoperative T lymphocytes counts and suppression of preoperative NK cells may be caused by high tumor burden and poorly differentiated tumor; surgery trauma could cause transiently decrease of postoperative T lymphocytes and NK cells. Key words: Colorectal cancer; Esophageal cancer; T-lymphocyte subset; NK cells