School of Medicine University of California-Riverside, Riverside, California; Department of Radiology, Loma Linda University, Loma Linda, California.
Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, California.
J Urol. 2018 May;199(5):1218-1223. doi: 10.1016/j.juro.2017.10.042. Epub 2017 Nov 8.
We sought to identify the clinical and magnetic resonance imaging variables predictive of biochemical recurrence after robotic assisted radical prostatectomy in patients who underwent multiparametric 3 Tesla prostate magnetic resonance imaging.
We performed an institutional review board approved, HIPAA (Health Insurance Portability and Accountability Act) compliant, single arm observational study of 3 Tesla multiparametric magnetic resonance imaging prior to robotic assisted radical prostatectomy from December 2009 to March 2016. Clinical, magnetic resonance imaging and pathological information, and clinical outcomes were compiled. Biochemical recurrence was defined as prostate specific antigen 0.2 ng/cc or greater. Univariate and multivariate regression analysis was performed.
Biochemical recurrence had developed in 62 of the 255 men (24.3%) included in the study at a median followup of 23.5 months. Compared to the subcohort without biochemical recurrence the subcohort with biochemical recurrence had a greater proportion of patients with a high grade biopsy Gleason score, higher preoperative prostate specific antigen (7.4 vs 5.6 ng/ml), intermediate and high D'Amico classifications, larger tumor volume on magnetic resonance imaging (0.66 vs 0.30 ml), higher PI-RADS® (Prostate Imaging-Reporting and Data System) version 2 category lesions, a greater proportion of intermediate and high grade radical prostatectomy Gleason score lesions, higher pathological T3 stage (all p <0.01) and a higher positive surgical margin rate (19.3% vs 7.8%, p = 0.016). On multivariable analysis only tumor volume on magnetic resonance imaging (adjusted OR 1.57, p = 0.016), pathological T stage (adjusted OR 2.26, p = 0.02), positive surgical margin (adjusted OR 5.0, p = 0.004) and radical prostatectomy Gleason score (adjusted OR 2.29, p = 0.004) predicted biochemical recurrence.
In this cohort tumor volume on magnetic resonance imaging and pathological variables, including Gleason score, staging and positive surgical margins, significantly predicted biochemical recurrence. This suggests an important new imaging biomarker.
我们旨在确定在接受多参数 3T 前列腺磁共振成像检查的患者中，哪些临床和磁共振成像变量可预测机器人辅助根治性前列腺切除术后的生化复发。
我们进行了一项机构审查委员会批准的、符合 HIPAA（健康保险流通与责任法案）的单臂观察性研究，纳入了 2009 年 12 月至 2016 年 3 月期间行机器人辅助根治性前列腺切除术前的多参数 3T 磁共振成像资料。我们汇总了临床、磁共振成像和病理信息以及临床结局。生化复发定义为前列腺特异性抗原（PSA）0.2ng/cc 或更高。进行了单变量和多变量回归分析。
在中位随访 23.5 个月时，255 例患者中有 62 例（24.3%）发生生化复发。与无生化复发的亚组相比，生化复发的亚组患者具有更高比例的高级别活检 Gleason 评分、更高的术前 PSA（7.4 比 5.6ng/ml）、中高危 D'Amico 分类、磁共振成像上更大的肿瘤体积（0.66 比 0.30ml）、更高的 PI-RADS®（前列腺成像报告和数据系统）第 2 版分类病变、更高比例的中高危根治性前列腺切除术后 Gleason 评分病变、更高的病理 T3 期（所有 p＜0.01）和更高的阳性切缘率（19.3%比 7.8%，p=0.016）。多变量分析显示，仅磁共振成像上的肿瘤体积（调整后的 OR 1.57，p=0.016）、病理 T 分期（调整后的 OR 2.26，p=0.02）、阳性切缘（调整后的 OR 5.0，p=0.004）和根治性前列腺切除术后 Gleason 评分（调整后的 OR 2.29，p=0.004）可预测生化复发。
在本队列中，磁共振成像上的肿瘤体积和病理变量（包括 Gleason 评分、分期和阳性切缘）显著预测了生化复发。这表明了一种新的重要影像学生物标志物。
