【摘要】 目的 分析不同阶段前列腺癌患者血清铜离子水平差异，及研究术前血清铜离子水平与前列腺癌根治患者手术相关指标的关系。方法 回顾性分析2020年3月至2024年9月接受检测血清铜离子的良性前列腺疾病患者200例；前列腺癌患者237例，包括非转移性前列腺癌169例，转移性前列腺癌48例。其中接受前列腺癌根治且未接受新辅助治疗患者129例。比较前列腺癌与良性前列腺疾病患者、不同阶段前列腺癌患者之间的血清铜离子水平，研究血清铜离子水平与接受前列腺癌根治且未接受新辅助治疗患者的前列腺特异性抗原（Prostate-specific antigen,PSA）、国际泌尿病理协会（International Society of Urological Pathology grading system,ISUP）分级、病理分期、病理升级、淋巴结转移、手术切缘、生化复发的关系。结果 前列腺癌患者中位血清铜离子水平高于良性前列腺疾病患者，分别为14.7(12.2～17.8)μmol/L和13.5(11.4～16.4)μmol/L(P=0.002)。转移性前列腺癌患者的中位血清铜离子高于非转移性前列腺癌（P<0.05），分别为19.6(15.9～23.5)μmol/L和14.0(11.8～16.0)μmol/L(P<0.05)。转移性去势抵抗性前列腺癌患者的中位血清铜离子高于转移性去势敏感性前列腺癌，分别为（23.0±4.3）μmol/L和（18.1±4.3）μmol/L(P<0.001)。对前列腺癌根治且未接受新辅助治疗患者129例进一步分析，pT2对比pT3，无病理升级对比病理升级，不同ISUP分级1～5对比、术后淋巴结阴性对比阳性、手术切缘阴性对比阳性，更差的术后病理特征的血清铜离子有升高趋势，但均无显著的统计学差异（P> 0.05）。血清铜离子水平与PSA不存在线性相关（相关系数=0.13,P=0.135），血清铜离子水平不是生化复发的预测因素（HR=1.02,95%CI0.87～1.20,P=0.821）。结论 前列腺癌患者有着更高的血清铜离子水平，特别在转移性前列腺癌及转移性去势抵抗性前列腺癌中显著升高。血清铜离子与前列腺癌存在着密切关系，可作为评估前列腺癌侵袭性的补充指标，但其阈值界定及因果机制仍需进一步验证。更多还原

【Abstract】 Objective To analyze the differences in serum copper ion levels among patients with prostate cancer(PCa)at different stages and to investigate the relationship between preoperative serum copper ion levels and surgical-related indicators in patients undergoing radical prostatectomy for PCa.Methods A retrospective analysis was conducted on 200 patients with benign prostatic diseases and 237 patients with PCa who had serum copper ion levels measured between March2020 and September 2024. Among the PCa cases, 169 were non-metastatic and 48 were metastatic. A total of 129 patients underwent radical prostatectomy without receiving neoadjuvant therapy. Serum copper ion levels were compared between patients with PCa and benign prostatic diseases, as well as among different stages of PCa. The associations between serum copper ion levels and prostate-specific antigen( PSA), International Society of Urological Pathology( ISUP) grade,pathological stage, pathological upgrading, lymph node metastasis, surgical margin status, and biochemical recurrence were further analyzed in patients who underwent radical prostatectomy without neoadjuvant therapy.Results The median serum copper level in patients with PCa was significantly higher than that in benign patients with PCa, at 14. 7(12. 2 ～ 17. 8)μmol/L and 13. 5(11. 4 ～ 16. 4) μmol/L, respectively(P= 0. 002). The median serum copper level in metastatic PCa was significantly higher than that in non-metastatic prostate cancer PCa, at 19. 6(15. 9 ～ 23. 5) μmol/L and 14. 0(11. 8 ～16. 0) μmol/L, respectively(P< 0. 05). Furthermore, the median serum copper ion level was significantly higher in metastatic castration-resistant prostate cancer(mCRPC) than that in metastatic castration-sensitive prostate cancer(mCSPC),at(23. 0 ± 4. 3) μmol/L and(18. 1 ± 4. 3) μmol/L, respectively(P< 0. 001). Further analysis of 129 patients who underwent radical prostatectomy without neoadjuvant therapy showed that higher serum copper ion levels tended to be associated with worse postoperative pathological features, including pT3 stage versus pT2 stage, pathological upgrading versus no upgrading, different ISUP grades(1 ～ 5), lymph node positivity versus negativity, and positive versus negative surgical margins; however, these differences were not statistically significant(P> 0. 05). Serum copper ion levels were not linearly correlated with PSA levels(correlation coefficient = 0. 13,P= 0. 135), and serum copper ion levels were not predictive of biochemical recurrence(HR= 1. 02, 95%CI: 0. 87 ～ 1. 20,P= 0. 821).Conclusion Patients with prostate cancer exhibit higher serum copper ion levels, especially those with metastatic prostate cancer and metastatic castration-resistant prostate cancer. Serum copper ions are closely associated with prostate cancer and may serve as a supplementary indicator for assessing tumor aggressiveness. However, the threshold values and underlying causal mechanisms require further investigation.更多还原