Wang Liang, Mullerad Michael, Chen Hui-Ni, Eberhardt Steven C, Kattan Michael W, Scardino Peter T, Hricak Hedvig
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Radiology. 2004 Jul;232(1):133-9. doi: 10.1148/radiol.2321031086. Epub 2004 May 27.
To assess the incremental value of endorectal magnetic resonance (MR) imaging findings in addition to clinical variables for prediction of extracapsular extension (ECE) in patients with prostate cancer.
In this cohort study, 344 consecutive patients with biopsy-proved prostate cancer underwent endorectal MR imaging prior to surgery; 216 of these patients also underwent MR spectroscopic imaging. MR images were interpreted by 10 attending radiologists. The likelihood of ECE was scored retrospectively on the basis of MR imaging reports. Clinical variables included serum prostate-specific antigen (PSA) level, Gleason score, clinical stage of tumor, greatest percentage of cancer in all core biopsy specimens, percentage of cancer-positive core specimens in all core biopsy specimens, and presence of perineural invasion. For data analysis, receiver operating characteristic (ROC) curves and univariate and multivariate logistic regression analyses were used. Jackknife analysis was used for prediction of probability from a model that included clinical variables as tested comparatively with a model that included the clinical variables plus endorectal MR imaging findings. A difference with P <.05 was considered significant.
At univariate analysis, all variables were associated with ECE. At ROC univariate analysis, endorectal MR imaging findings had the largest area under the ROC curve. At multivariate analysis, serum PSA level, percentage of cancer in all core biopsy specimens, and endorectal MR imaging findings (P =.001, P =.001, and P <.001, respectively) were predictors of ECE. Areas under ROC curve for two models, with and without endorectal MR imaging findings, were 0.838 and 0.772, respectively (P =.022).
A model containing endorectal MR imaging findings has a significantly larger area under the ROC curve than a model containing only clinical variables; thus, endorectal MR imaging findings add incremental value in the prediction of ECE.
评估除临床变量外，直肠内磁共振（MR）成像结果对预测前列腺癌患者包膜外侵犯（ECE）的增量价值。
在这项队列研究中，344例经活检证实为前列腺癌的连续患者在手术前行直肠内MR成像；其中216例患者还接受了磁共振波谱成像。MR图像由10名放射科主治医师解读。根据MR成像报告对ECE的可能性进行回顾性评分。临床变量包括血清前列腺特异性抗原（PSA）水平、Gleason评分、肿瘤临床分期、所有核心活检标本中癌的最大百分比、所有核心活检标本中癌阳性核心标本的百分比以及神经周围侵犯的存在情况。数据分析采用受试者操作特征（ROC）曲线以及单变量和多变量逻辑回归分析。采用留一法分析，从一个包含临床变量的模型中预测概率，并与一个包含临床变量加直肠内MR成像结果的模型进行比较。P <.05的差异被认为具有统计学意义。
在单变量分析中，所有变量均与ECE相关。在ROC单变量分析中，直肠内MR成像结果的ROC曲线下面积最大。在多变量分析中，血清PSA水平、所有核心活检标本中癌的百分比以及直肠内MR成像结果（分别为P =.001、P =.001和P <.001）是ECE的预测因素。有和没有直肠内MR成像结果的两个模型的ROC曲线下面积分别为0.838和0.772（P =.022）。
包含直肠内MR成像结果的模型的ROC曲线下面积显著大于仅包含临床变量的模型；因此，直肠内MR成像结果在预测ECE方面具有增量价值。
