Wang Liang, Hricak Hedvig, Kattan Michael W, Chen Hui Ni, Kuroiwa Kentaro, Eisenberg Halley F, Scardino Peter T
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Radiology. 2007 Jan;242(1):182-8. doi: 10.1148/radiol.2421051254. Epub 2006 Nov 7.
To retrospectively determine whether endorectal magnetic resonance (MR) imaging findings contribute incremental value to the Kattan nomogram for predicting seminal vesicle invasion (SVI) in patients with prostate cancer.
The institutional review board issued a waiver of authorization, which included a waiver of informed consent, for this HIPAA-compliant study. From October 2000 through January 2005, 573 patients (mean age, 58.3 years; age range, 36-86 years) underwent endorectal MR imaging before prostate cancer surgery. The endorectal MR imaging results had been prospectively interpreted by seven radiologists, and the likelihood of SVI was retrospectively scored on the basis of radiologists' written reports. MR imaging findings, individual clinical variables (serum prostate-specific antigen [PSA] level, Gleason grade, clinical stage, greatest percentage of cancer in all biopsy cores, percentage of positive cores in all biopsy cores, and perineural invasion), and the Kattan nomogram were evaluated with respect to SVI prediction; surgical pathologic analysis was used as the reference standard. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed.
At pathologic analysis, 28 (4.9%) of 573 patients had SVI. At univariate analysis, endorectal MR imaging results and all clinical variables except the percentage of positive biopsy cores were significantly associated with SVI (P<.02); endorectal MR imaging (0.76) had a larger area under the ROC curve (AUC) than any clinical variable (0.62-0.73). At multivariate analysis, endorectal MR imaging results, Gleason grade, PSA level, and the percentage of cancer in all biopsy cores were significantly associated with SVI (P<or=.02). The Kattan nomogram plus endorectal MR imaging (0.87) had a significantly larger (P<.05) AUC than either endorectal MR imaging alone (0.76) or the Kattan nomogram alone (0.80).
The addition of endorectal MR imaging contributes significant incremental value to the Kattan nomogram for predicting SVI.
回顾性确定直肠内磁共振（MR）成像结果对于Kattan列线图预测前列腺癌患者精囊侵犯（SVI）是否具有额外价值。
对于这项符合健康保险流通与责任法案（HIPAA）的研究，机构审查委员会批准豁免授权，其中包括豁免知情同意。2000年10月至2005年1月期间，573例患者（平均年龄58.3岁；年龄范围36 - 86岁）在前列腺癌手术前行直肠内MR成像检查。直肠内MR成像结果由7名放射科医生进行前瞻性解读，并根据放射科医生的书面报告对SVI的可能性进行回顾性评分。针对SVI预测，评估MR成像结果、个体临床变量（血清前列腺特异性抗原[PSA]水平、Gleason分级、临床分期、所有活检组织芯中癌的最大百分比、所有活检组织芯中阳性组织芯的百分比以及神经周围侵犯情况）以及Kattan列线图；手术病理分析用作参考标准。进行逻辑回归和受试者操作特征（ROC）曲线分析。
病理分析显示，573例患者中有28例（4.9%）发生SVI。单因素分析时，直肠内MR成像结果以及除阳性活检组织芯百分比之外的所有临床变量均与SVI显著相关（P <.02）；直肠内MR成像（0.76）的ROC曲线下面积（AUC）大于任何临床变量（0.62 - 0.73）。多因素分析时，直肠内MR成像结果、Gleason分级、PSA水平以及所有活检组织芯中癌的百分比均与SVI显著相关（P≤.02）。Kattan列线图联合直肠内MR成像（0.87）的AUC显著大于单独直肠内MR成像（0.76）或单独Kattan列线图（0.80）（P <.05）。
添加直肠内MR成像对于Kattan列线图预测SVI具有显著的额外价值。
