Department of Urology, Keio University School of Medicine, Tokyo, Japan.
BJU Int. 2014 May;113(5):741-7. doi: 10.1111/bju.12329. Epub 2013 Aug 13.
To evaluate the suitability of preoperative multiparametric magnetic resonance imaging (MRI) positivity as a predictor of biochemical recurrence after radical prostatectomy (RP).
We reviewed the clinical records of patients who underwent either standard RP or laparoscopic RP between January 2005 and December 2009 at our institution. Patients who received radiotherapy or androgen deprivation therapy before surgery were excluded. A total of 314 patients met the study inclusion criteria. Cox proportional hazard regression models were used for analyses. In accordance with the criteria in the established guidelines, a radiologist scored the probability of the presence of prostate cancer using a five-point scale of diagnostic confidence level. The highest confidence level of any pulse sequence was considered as the evaluation result.
MRI positivity was significantly associated with a high clinical stage (cT ≥ 2; P = 0.039), a high positive biopsy core rate (≥0.2; P < 0.001), a high biopsy Gleason score ([GS] ≥8; P < 0.001) and a high pathological GS (≥8; P = 0.005). Univariate analysis and multivariate analysis showed that MRI positivity was a prognostic indicator in the analysis that included only preoperative variables and also in the analysis including preoperative and pathological variables.
Multiparametric MRI positivity can independently predict biochemical recurrence after RP.
评估术前多参数磁共振成像（MRI）阳性作为根治性前列腺切除术（RP）后生化复发预测指标的适宜性。
我们回顾了 2005 年 1 月至 2009 年 12 月期间在我院接受标准 RP 或腹腔镜 RP 的患者的临床记录。排除了在术前接受放疗或雄激素剥夺治疗的患者。共有 314 名患者符合研究纳入标准。采用 Cox 比例风险回归模型进行分析。根据既定指南中的标准，放射科医生使用诊断置信水平的五分制对前列腺癌存在的可能性进行评分。任何脉冲序列的最高置信度被认为是评估结果。
MRI 阳性与较高的临床分期（cT≥2；P=0.039）、较高的阳性活检核心率（≥0.2；P<0.001）、较高的活检 Gleason 评分（[GS]≥8；P<0.001）和较高的病理 GS（≥8；P=0.005）显著相关。单因素分析和多因素分析表明，MRI 阳性是仅包括术前变量分析和包括术前和病理变量分析中的预后指标。
多参数 MRI 阳性可独立预测 RP 后的生化复发。
