确定中高危前列腺癌中卫星病灶的分布：对聚焦放疗的意义
Establishing the distribution of satellite lesions in intermediate- and high-risk prostate cancer: implications for focused radiotherapy.
作者信息
Hegde J V, Margolis D J, Wang P-C, Reiter R E, Huang J, Steinberg M L, Kamrava M
机构信息
Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Radiology, University of California, Los Angeles, Los Angeles, CA, USA.
出版信息
Prostate Cancer Prostatic Dis. 2017 Jun;20(2):241-248. doi: 10.1038/pcan.2016.75. Epub 2017 Jan 31.
BACKGROUND
In focused radiotherapy for prostate cancer (PC), a full dose of radiation is delivered to the index lesion while reduced dose is delivered to the remaining prostate to reduce morbidity. As PC is commonly multifocal, we investigated whether baseline clinical characteristics or multiparametric magnetic resonance imaging (mpMRI) may be useful to predict the actual pathologic distribution of PC in men with intermediate- or high-risk PC, which may better inform how to deliver focused radiotherapy.
METHODS
A retrospective single-institutional study was performed on 71 consecutive men with clinically localized, intermediate- or high-risk PC who underwent mpMRI followed by radical prostatectomy (RP) from January 2012 to December 2012. Logistic regression analysis was performed to evaluate preoperative predictors for satellite lesions. Performance characteristics of mpMRI to detect satellite lesions and the extent of prostate disease (one hemi-gland vs both) were also evaluated.
RESULTS
In all, 50.7% had satellite lesions on mpMRI. On RP specimen analysis, 66.2% had satellite lesions and 55.3% of these satellite lesions had pathologic Gleason score (pGS)⩾3+4. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for mpMRI detecting a satellite lesion being present in the RP specimen were 59.6%, 66.7%, 77.8%, 45.7% and 62.0%, respectively. The presence of MRI satellite lesions was the only preoperative predictor significantly associated with finding satellite lesions on final pathology (hazard ratio (HR), 2.95, P=0.040). There was agreement in 76.1% of the entire cohort for unilateral vs bilateral disease when incorporating both biopsy and mpMRI information and comparing with the RP specimen.
CONCLUSIONS
In intermediate risk or greater PC, only the presence of mpMRI satellite lesions could predict for pathologic satellite lesions. While combining biopsy and mpMRI information may improve preoperative disease localization, the relatively high incidence of bilateral hemi-gland involvement with pGS ⩾7 satellite lesions makes it challenging to appropriately select men eligible for hemi-gland therapy.
背景
在前列腺癌（PC）的聚焦放疗中，全剂量辐射作用于索引病灶，而降低剂量辐射作用于其余前列腺组织以降低发病率。由于PC通常为多灶性，我们研究了基线临床特征或多参数磁共振成像（mpMRI）是否有助于预测中危或高危PC男性患者PC的实际病理分布，这可能有助于更好地指导聚焦放疗的实施方式。
方法
对2012年1月至2012年12月期间连续71例临床局限性、中危或高危PC患者进行回顾性单机构研究，这些患者接受了mpMRI检查，随后进行了根治性前列腺切除术（RP）。进行逻辑回归分析以评估卫星病灶的术前预测因素。还评估了mpMRI检测卫星病灶及前列腺疾病范围（一侧半腺体与双侧）的性能特征。
结果
总体而言，50.7%的患者在mpMRI上有卫星病灶。在RP标本分析中，66.2%的患者有卫星病灶，其中55.3%的卫星病灶病理Gleason评分（pGS）⩾3+4。mpMRI检测RP标本中存在卫星病灶的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为59.6%、66.7%、77.8%、45.7%和62.0%。MRI卫星病灶的存在是与最终病理发现卫星病灶显著相关的唯一术前预测因素（风险比（HR），2.95，P=0.040）。纳入活检和mpMRI信息并与RP标本比较时，整个队列中76.1%的患者在单侧与双侧疾病方面达成一致。
结论
在中危或更高风险的PC中，只有mpMRI卫星病灶的存在可预测病理卫星病灶。虽然结合活检和mpMRI信息可能改善术前疾病定位，但pGS⩾7卫星病灶导致双侧半腺体受累的发生率相对较高，这使得适当选择适合半腺体治疗的男性患者具有挑战性。
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