目的 探寻转移性前列腺癌的临床危险因素。 方法 回顾2019年1月至2024年3月于川北医学院附属医院泌尿外科首次入院后病理检查诊断为前列腺癌的180例患者的临床资料，收集患者年龄、体质指数、Gleason评分、术前游离前列腺特异性抗原（free prostate-specific antigen，FPSA）/总前列腺特异性抗原（total prostate-specific antigen，TPSA）比值（F/T比值）、血浆纤维蛋白原、中性粒细胞、血小板、淋巴细胞、单核细胞、中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、血小板-淋巴细胞比值（platelet to lymphocyte ratio，PLR）、单核细胞计数与淋巴细胞计数比值（monocyte-lymphocyte count ratio，MLR）、全身免疫炎症指数（systemic immune-inflammation index，SII），前列腺体积、TPSA，碱性磷酸酶、吸烟史、饮酒史。根据诊断分为局限性前列腺癌组99例和转移性前列腺癌组81例，采用Mann-Whitney U检验、χ² 检验和多因素logistic回归分析分别对变量进行分析，探寻转移性前列腺癌的临床危险因素。 结果 单因素分析结果显示，患者体质指数（U=-2.456，P<0.014）、Gleason评分（U=6.801，P=0.000）、血浆纤维蛋白原（U=3.360，P=0.001）、淋巴细胞（U=-2.963，P=0.003）、NLR（U=2.096，P=0.036）、PLR（U=2.503，P=0.012）、MLR（U=2.434，P=0.015），TPSA（χ²=30.462，P=0.000），碱性磷酸酶（χ²=36.719，P=0.000）比较差异有统计学意义。将有统计学意义的指标纳入多因素logistic回归分析，结果显示：体质指数降低、Gleason评分升高、TPSA>20 ug/L，碱性磷酸酶≥90 ng/mL是转移性前列腺癌的独立危险因素。 结论 对于初次入院诊断为前列腺癌的患者，发现其体质指数低，Gleason评分高，TPSA>20 ug/L，碱性磷酸酶≥90 ng/mL的患者应该进一步评估病情的严重程度，以明确是否发生转移。

Objective To explore clinical risk factors for metastatic prostate cancer. Methods We retrospectively analyzed the clinical data of 180 patients with prostate cancer diagnosed with pathological examination during their first hospitalization in the Department of Urology of the Affiliated Hospital of North Sichuan Medical College from January 2019 to March 2024，involving the patients’ age，body mass index，Gleason score，and preoperative parameters including the ratio of free prostate-specific antigen（FPSA） to total prostate-specific antigen（TPSA），plasma fibrinogen level，neutrophil count，platelet count，lymphocyte count，monocyte count，neutrophil-to-lymphocyte ratio（NLR），platelet-to-lymphocyte ratio（PLR），monocyte-to-lymphocyte ratio（MLR），the systemic immune-inflammation index（SII），prostate volume，TPSA level，alkaline phosphatase level，and smoking and alcohol drinking history. Among the patients，99 were diagnosed as localized prostate cancer，and 81 were diagnosed as metastatic prostate cancer. The Mann-Whitney U test，χ² test，and multivariable logistic regression analysis were performed to determine clinical risk factors for metastatic prostate cancer. Results The univariable analyses detected significant differences in the body mass index（U=-2.456，P<0.014），Gleason score（U=6.801，P<0.001），plasma fibrinogen level（U=3.360，P=0.001），lymphocyte count（U=-2.963，P=0.003），NLR（U=2.096，P=0.036），PLR（U=2.503，P=0.012），MLR（U=2.434，P=0.015），TPSA level（χ²=30.462，P<0.001），and alkaline phosphatase level（χ²=36.719，P<0.001）. The multivariable logistic regression analysis incorporating these significant indicators showed that a decreased body mass index，an increased Gleason score，TPSA level >20 ug/L，and alkaline phosphatase level ≥90 ng/mL were independent risk factors for metastatic prostate cancer. Conclusion For newly diagnosed patients with prostate cancer，those with a low body mass index，a high Gleason score，TPSA level >20 ug/L，and alkaline phosphatase level ≥90 ng/mL should be further evaluated to determine whether metastasis occurs.