根据前列腺癌研究国际：主动监测标准，适合主动监测的临床意义不大的前列腺癌：PI-RADS v2 的实用性。
Clinically insignificant prostate cancer suitable for active surveillance according to Prostate Cancer Research International: Active surveillance criteria: Utility of PI-RADS v2.
机构信息
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
出版信息
J Magn Reson Imaging. 2018 Apr;47(4):1072-1079. doi: 10.1002/jmri.25856. Epub 2017 Sep 13.
BACKGROUND
Active surveillance (AS) is an important treatment strategy for prostate cancer (PCa). Prostate Imaging-Reporting and Data System (PI-RADS) v2 has been addressed, but few studies have reported the value of PI-RADS v2 for assessing risk stratification in patients with PCa, especially on selecting potential candidates for AS.
PURPOSE
To investigate the utility of PI-RADS v2 and apparent diffusion coefficient (ADC) in evaluating patients with insignificant PCa, who are suitable for AS.
STUDY TYPE
Retrospective.
SUBJECTS
In all, 238 patients with PCa who met the Prostate Cancer Research International: Active Surveillance criteria underwent radical prostatectomy.
FIELD STRENGTH/SEQUENCE: 3.0T, including T -weighted, diffusion-weighted, and dynamic contrast-enhanced imaging.
ASSESSMENT
Insignificant cancer was defined histopathologically as an organ-confined disease with a tumor volume <0.5 cm without Gleason score 4-5. Patients were divided into two groups based on the PI-RADS v2 and tumor ADC: A, PI-RADS score ≤3 and ADC ≥1.095 × 10 mm /s; and B, PI-RADS score 4-5 or ADC <1.095 × 10 mm /s. Preoperative clinical and imaging variables were evaluated regarding the associations with insignificant cancer.
RESULTS
Of the 238 patients, 101 (42.8%) were diagnosed with insignificant cancer on pathological findings. The number of positive cores, prostate-specific antigen density (PSAD), PI-RADS v2 and tumor ADC were significantly associated with insignificant cancer on univariate analysis (P < 0.05). However, multivariate analysis indicated tumor ADC (odds ratio [OR] = 4.57, P < 0.001) and PI-RADS v2 (OR = 3.60, P < 0.001) were independent predictors of insignificant cancer. Area under the receiver operating characteristics curve (AUC) reached 0.803 when PI-RADS v2 (AUC = 0.747) was combined with tumor ADC (AUC = 0.786).
DATA CONCLUSION
The PI-RADS v2 together with tumor ADC may be a useful marker for predicting patients with insignificant PCa when considering AS.
LEVEL OF EVIDENCE
4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1072-1079.
背景
主动监测（AS）是前列腺癌（PCa）的重要治疗策略。前列腺成像报告和数据系统（PI-RADS）v2 已经得到了关注，但很少有研究报告 PI-RADS v2 用于评估 PCa 患者的风险分层的价值，尤其是在选择潜在的 AS 候选者方面。
目的
探讨 PI-RADS v2 和表观扩散系数（ADC）在评估适合 AS 的具有局灶性前列腺癌的患者中的作用。
研究类型
回顾性。
受试者
共有 238 名符合前列腺癌研究国际：主动监测标准的 PCa 患者接受了根治性前列腺切除术。
磁场强度/序列：3.0T，包括 T1 加权、弥散加权和动态对比增强成像。
评估
组织病理学上，局灶性癌定义为肿瘤体积<0.5cm 且 Gleason 评分<4-5 的器官局限性疾病。根据 PI-RADS v2 和肿瘤 ADC 将患者分为两组：A 组，PI-RADS 评分≤3 且 ADC≥1.095×10mm/s；B 组，PI-RADS 评分 4-5 或 ADC<1.095×10mm/s。评估术前临床和影像学变量与局灶性癌的关系。
结果
在 238 名患者中，101 名（42.8%）患者的病理结果诊断为局灶性癌。单变量分析显示，阳性核心数、前列腺特异性抗原密度（PSAD）、PI-RADS v2 和肿瘤 ADC 与局灶性癌显著相关（P<0.05）。然而，多变量分析表明，肿瘤 ADC（比值比[OR]＝4.57，P<0.001）和 PI-RADS v2（OR＝3.60，P<0.001）是局灶性癌的独立预测因子。当 PI-RADS v2（AUC＝0.747）与肿瘤 ADC（AUC＝0.786）联合使用时，受试者工作特征曲线（ROC）下面积（AUC）达到 0.803。
数据结论
PI-RADS v2 联合肿瘤 ADC 可能是预测接受 AS 治疗的局灶性 PCa 患者的有用标志物。
证据水平
4 级 技术功效：阶段 2 J. Magn. Reson. Imaging 2018；47：1072-1079.
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