Urology Division, National Cancer Center Hospital, Tokyo, Japan.
Int J Urol. 2013 Oct;20(10):993-9. doi: 10.1111/iju.12091. Epub 2013 Jan 29.
Recent studies have shown an improvement in prostate cancer diagnosis with the use of 3.0-Tesla magnetic resonance imaging. We retrospectively assessed the ability of this imaging technique to predict side-specific extracapsular extension of prostate cancer.
From October 2007 to August 2011, prostatectomy was carried out in 396 patients after preoperative 3.0-Tesla magnetic resonance imaging. Among these, 132 (primary sample) and 134 patients (validation sample) underwent 12-core prostate biopsy at the National Cancer Center Hospital of Tokyo, Japan, and at other institutions, respectively. In the primary dataset, univariate and multivariate analyses were carried out to predict side-specific extracapsular extension using variables determined preoperatively, including 3.0-Tesla magnetic resonance imaging findings (T2-weighted and diffusion-weighted imaging). A prediction model was then constructed and applied to the validation study sample.
Multivariate analysis identified four significant independent predictors (P < 0.05), including a biopsy Gleason score of ≥8, positive 3.0-Tesla diffusion-weighted magnetic resonance imaging findings, ≥2 positive biopsy cores on each side and a maximum percentage of positive cores ≥31% on each side. The negative predictive value was 93.9% in the combination model with these four predictors, meanwhile the positive predictive value was 33.8%. Good reproducibility of these four significant predictors and the combination model was observed in the validation study sample.
The side-specific extracapsular extension prediction by the biopsy Gleason score and factors associated with tumor location, including a positive 3.0-Tesla diffusion-weighted magnetic resonance imaging finding, have a high negative predictive value, but a low positive predictive value.
最近的研究表明，使用 3.0T 磁共振成像可以提高前列腺癌的诊断水平。我们回顾性评估了这种成像技术预测前列腺癌侧方包膜外侵犯的能力。
2007 年 10 月至 2011 年 8 月，在术前进行了 3.0T 磁共振成像后，对 396 例患者进行了前列腺切除术。其中，132 例（原发性样本）和 134 例（验证性样本）分别在日本东京国立癌症中心医院和其他机构进行了 12 核前列腺活检。在原发性数据集，使用术前确定的变量（包括 3.0T 磁共振成像发现（T2 加权和弥散加权成像））进行单变量和多变量分析，以预测侧方包膜外侵犯。然后构建预测模型并应用于验证性研究样本。
多变量分析确定了四个显著的独立预测因子（P<0.05），包括活检 Gleason 评分≥8、3.0T 弥散加权磁共振成像阳性、双侧各有≥2 个阳性活检核心和每侧阳性核心的最大百分比≥31%。在组合模型中，这四个预测因子的阴性预测值为 93.9%，而阳性预测值为 33.8%。在验证性研究样本中，观察到这四个显著预测因子和组合模型具有良好的可重复性。
活检 Gleason 评分和与肿瘤位置相关的因素（包括 3.0T 弥散加权磁共振成像阳性）对侧方包膜外侵犯的预测具有较高的阴性预测值，但阳性预测值较低。
