Fuchsjäger Michael H, Shukla-Dave Amita, Hricak Hedvig, Wang Liang, Touijer Karim, Donohue John F, Eastham James A, Kattan Michael W
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
BJU Int. 2009 Aug;104(3):315-20. doi: 10.1111/j.1464-410X.2009.08406.x. Epub 2009 Feb 11.
To investigate whether magnetic resonance imaging (MRI) findings, when converted into a scoring system, can predict the biochemical recurrence of prostate cancer after radical prostatectomy (RP).
Between January 2000 and October 2004, 610 patients with biopsy-confirmed prostate cancer had MRI before RP, with whole-mount step-sectioning of the pathology sample. MRI findings were retrospectively scored on a seven-point scale based on Tumour-Node-Mestastasis staging (1, no tumour seen, to 7, lymph node metastasis). MRI scores were added to published 5- and 10-year clinical preoperative nomograms for predicting recurrence. The predictive accuracy of MRI was quantified as the differences in bootstrap-corrected concordance indices of the models with and without MRI.
As of August 2007, 64 (10.5%) patients had a biochemical recurrence. MRI scores were associated with recurrence (P < 0.001) with hazard ratios of 1.76 and 1.81 in the 5- and 10-year models, respectively. Actual recurrence rates by MRI score were: 1, 0%; 2, 4.5%; 3, 9%; 4, 24.1%; 5, 33.3%; 6, 69.2%; 7, 100%. When MRI was added, the concordance indices of the 5- and 10-year models increased, from 0.762 to 0.776 (P = 0.081) and 0.773 to 0.788 (P = 0.107), respectively; the improvement was not significant.
The MRI scoring system devised was a strong predictor of biochemical recurrence after RP. Although MRI did not provide added prognostic value to standard clinical nomograms, in centres where MRI is used routinely, it might increase the confidence of the clinician in assessing the risk of recurrence by contributing supporting data.
探讨磁共振成像（MRI）结果转化为评分系统后，能否预测前列腺癌根治术（RP）后前列腺癌的生化复发。
2000年1月至2004年10月期间，610例经活检确诊的前列腺癌患者在RP前接受了MRI检查，并对病理样本进行了全层连续切片检查。根据肿瘤-淋巴结-转移（TNM）分期，对MRI结果进行回顾性七点评分（1分，未见肿瘤；至7分，淋巴结转移）。将MRI评分添加到已发表的预测复发的5年和10年临床术前列线图中。MRI的预测准确性通过有和没有MRI的模型的自展校正一致性指数的差异来量化。
截至2007年8月，64例（10.5%）患者出现生化复发。MRI评分与复发相关（P<0.001），在5年和10年模型中的风险比分别为1.76和1.81。按MRI评分的实际复发率为：1分，0%；2分，4.5%；3分，9%；4分，24.1%；5分，33.3%；6分，69.2%；7分，100%。添加MRI后，5年和10年模型的一致性指数分别从0.762提高到0.776（P = 0.081）和从0.773提高到0.788（P = 0.107）；改善不显著。
所设计的MRI评分系统是RP后生化复发的有力预测指标。虽然MRI未为标准临床列线图提供额外的预后价值，但在常规使用MRI的中心，它可能通过提供支持数据来增加临床医生评估复发风险的信心。
