Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
Urology. 2014 Jul;84(1):153-7. doi: 10.1016/j.urology.2014.04.006.
To investigate the relationship between prostate volume measured from preoperative imaging and adverse pathologic features at the time of radical prostatectomy and evaluate the potential effect of clinical stage on such relationship.
In 1756 men who underwent preoperative magnetic resonance imaging and radical prostatectomy from 2000 to 2010, we examined associations of magnetic resonance imaging-measured prostate volume with pathologic outcomes using univariate logistic regression and with postoperative biochemical recurrence using Cox proportional hazards models. We also analyzed the effects of clinical stage on the relationship between prostate volume and adverse pathologic features via interaction analyses.
In univariate analyses, smaller prostate volume was significantly associated with high pathologic Gleason score (P<.0001), extracapsular extension (P<.0001), and positive surgical margins (P=.032). No significant interaction between clinical stage and prostate volume was observed in predicting adverse pathologic features (all P>.05). The association between prostate volume and recurrence was significant in a multivariable analysis adjusting for postoperative variables (P=.031) but missed statistical significance in the preoperative model (P=.053). Addition of prostate volume did not change C-Indices (0.78 and 0.83) of either model.
Although prostate size did not enhance the prediction of recurrence, it is associated with aggressiveness of prostate cancer. There is no evidence that this association differs depending on clinical stage. Prospective studies are warranted assessing the effect of initial method of detection on the relationship between volume and outcome.
研究术前影像学测量的前列腺体积与根治性前列腺切除术后不良病理特征之间的关系，并评估临床分期对这种关系的潜在影响。
在 2000 年至 2010 年间，对 1756 名接受术前磁共振成像和根治性前列腺切除术的男性进行研究，我们使用单因素逻辑回归和 Cox 比例风险模型分析磁共振成像测量的前列腺体积与病理结果之间的关系，使用 Cox 比例风险模型分析前列腺体积与术后生化复发之间的关系。我们还通过交互分析分析了临床分期对前列腺体积与不良病理特征之间关系的影响。
在单因素分析中，较小的前列腺体积与较高的病理 Gleason 评分（P<.0001）、包膜外延伸（P<.0001）和阳性手术切缘（P=.032）显著相关。在预测不良病理特征时，临床分期与前列腺体积之间没有观察到显著的交互作用（所有 P>.05）。在调整术后变量的多变量分析中，前列腺体积与复发之间存在显著关联（P=.031），但在术前模型中未达到统计学意义（P=.053）。加入前列腺体积并没有改变两个模型的 C-指数（0.78 和 0.83）。
尽管前列腺大小不能增强对复发的预测，但它与前列腺癌的侵袭性有关。没有证据表明这种关联因临床分期而异。需要进行前瞻性研究评估初始检测方法对体积与结果之间关系的影响。
