Thurtle David, Hsu Ray C J, Chetan Madhurima, Lophatananon Artitaya, Hubbard Rachel, Gnanapragasam Vincent J, Barrett Tristan
Academic Urology Group, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK.
Cambridge University Clinical School, Cambridge CB2 0SP, UK.
Br J Cancer. 2016 Nov 22;115(11):1285-1288. doi: 10.1038/bjc.2016.353. Epub 2016 Nov 1.
There remains uncertainty on the need for bone staging in men with intermediate-risk prostate cancer. Current guidelines do not use mpMRI-staging information and rely on historic pathology grading.
We investigated the ability of mpMRI and the new Grade Group system to better predict bone metastasis status in a retrospective cohort study of 438 men with prostate cancer undergoing baseline mpMRI and isotope bone scintigraphy (BS).
Including mpMRI-staging information significantly increased the specificity of bone metastasis detection from 3.0% to 24.2% (P<0.01) and sensitivity from 89.2% to 97.3%. The new Grade Group score demonstrated progressive increase in bone metastasis rates (P<0.001). A novel risk-stratification model combining Grade Groups, PSA and mpMRI staging shows promise in predicting bone metastasis and could potentially reduce BS usage by 22.4%-34.7%.
Incorporating the new Grade Group system and mpMRI staging more accurately identified bone metastatic risk and suggests men with Grade Group ⩽2 and/or without radiological T3 disease could safely avoid routine bone staging.
对于中危前列腺癌男性患者是否需要进行骨分期仍存在不确定性。当前指南未采用多参数磁共振成像（mpMRI）分期信息，而是依赖既往病理分级。
在一项对438例接受基线mpMRI和同位素骨扫描（BS）的前列腺癌男性患者的回顾性队列研究中，我们调查了mpMRI和新的分级组系统对更好预测骨转移状态的能力。
纳入mpMRI分期信息显著提高了骨转移检测的特异性，从3.0%提高到24.2%（P<0.01），敏感性从89.2%提高到97.3%。新的分级组评分显示骨转移率呈逐步上升趋势（P<0.001）。一种结合分级组、前列腺特异抗原（PSA）和mpMRI分期的新型风险分层模型在预测骨转移方面显示出前景，并且有可能将BS的使用减少22.4% - 34.7%。
纳入新的分级组系统和mpMRI分期能更准确地识别骨转移风险，并表明分级组≤2和/或无影像学T3期疾病的男性患者可安全地避免常规骨分期。
