磁共振成像测定肿瘤接触长度对前列腺癌囊外侵犯的预测价值。

Predictive value of magnetic resonance imaging determined tumor contact length for extracapsular extension of prostate cancer.

机构信息

University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California.

Department of Radiology, Oslo University Hospital Aker, Oslo University Hospital, Oslo, Norway.

出版信息

J Urol. 2015 Feb;193(2):466-72. doi: 10.1016/j.juro.2014.08.084. Epub 2014 Aug 20.

DOI:10.1016/j.juro.2014.08.084

PMID:25150643

Abstract

PURPOSE

Tumor contact length is defined as the amount of prostate cancer in contact with the prostatic capsule. We evaluated the ability of magnetic resonance imaging determined tumor contact length to predict microscopic extracapsular extension compared to existing predictors of extracapsular extension.

MATERIALS AND METHODS

We retrospectively analyzed the records of 111 consecutive patients with magnetic resonance imaging/ultrasound fusion targeted, biopsy proven prostate cancer who underwent radical prostatectomy from January 2010 to July 2013. Median patient age was 64 years and median prostate specific antigen was 8.9 ng/ml. Clinical stage was cT1 in 93 cases (84%) and cT2 in 18 (16%). Postoperative pathological analysis confirmed pT2 in 71 patients (64%) and pT3 in 40 (36%). We evaluated 1) in the radical prostatectomy specimen the correlation of microscopic extracapsular extension with pathological cancer volume, pathological tumor contact length and Gleason score, 2) the correlation between microscopic extracapsular extension and magnetic resonance imaging tumor contact length, and 3) the ability of preoperative variables to predict microscopic extracapsular extension.

RESULTS

Logistic regression analysis revealed that pathological tumor contact length correlated better with microscopic extracapsular extension than the predictive power of pathological cancer volume (0.821 vs 0.685). The Spearman correlation between pathological and magnetic resonance imaging tumor contact length was r = 0.839 (p <0.0001). ROC AUC analysis revealed that magnetic resonance imaging tumor contact length outperformed cancer core involvement on targeted biopsy and the Partin tables to predict microscopic extracapsular extension (0.88 vs 0.70 and 0.63, respectively). At a magnetic resonance imaging tumor contact length threshold of 20 mm the accuracy for diagnosing microscopic extracapsular extension was superior to that of conventional magnetic resonance imaging criteria (82% vs 67%, p = 0.015). We developed a predicted probability plot curve of extracapsular extension according to magnetic resonance imaging tumor contact length.

CONCLUSIONS

Magnetic resonance imaging determined tumor contact length could be a promising quantitative predictor of microscopic extracapsular extension.

摘要

目的

肿瘤接触长度定义为与前列腺包膜接触的前列腺癌的量。我们评估了磁共振成像确定的肿瘤接触长度预测微观包膜外延伸的能力与现有的包膜外延伸预测因子相比。

材料和方法

我们回顾性分析了 2010 年 1 月至 2013 年 7 月连续 111 例接受磁共振成像/超声融合靶向活检证实前列腺癌行根治性前列腺切除术的患者的记录。中位患者年龄为 64 岁，中位前列腺特异性抗原为 8.9ng/ml。临床分期为 93 例（84%）cT1 和 18 例（16%）cT2。术后病理分析证实 71 例（64%）为 pT2，40 例（36%）为 pT3。我们评估了 1）在根治性前列腺切除标本中，微观包膜外延伸与病理癌症体积、病理肿瘤接触长度和 Gleason 评分的相关性，2）微观包膜外延伸与磁共振成像肿瘤接触长度的相关性，3）术前变量预测微观包膜外延伸的能力。

结果

Logistic 回归分析显示，病理肿瘤接触长度与微观包膜外延伸的相关性优于预测癌症体积的能力（0.821 比 0.685）。病理和磁共振成像肿瘤接触长度之间的斯皮尔曼相关性为 r = 0.839（p <0.0001）。ROC AUC 分析显示，磁共振成像肿瘤接触长度优于靶向活检的癌症核心受累和帕丁表预测微观包膜外延伸（0.88 比 0.70 和 0.63）。在磁共振成像肿瘤接触长度阈值为 20mm 时，诊断微观包膜外延伸的准确性优于常规磁共振成像标准（82%比 67%，p = 0.015）。我们根据磁共振成像肿瘤接触长度制定了包膜外延伸的预测概率图曲线。