Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Genitourin Cancer. 2018 Aug;16(4):281-287. doi: 10.1016/j.clgc.2018.02.015. Epub 2018 Feb 23.
The objective of this study was to investigate the effect of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) on prediction of postoperative Gleason score (GS) upgrading for patients with biopsy GS 6 prostate cancer.
We retrospectively reviewed 443 patients who underwent magnetic resonance imaging (MRI) and radical prostatectomy for biopsy-proven GS 6 prostate cancer between January 2011 and December 2013. Preoperative clinical variables and pathologic GS were examined, and all MRI findings were assessed with PI-RADSv2. Receiver operating characteristic curves were used to compare predictive accuracies of multivariate logistic regression models with or without PI-RADSv2.
Of the total 443 patients, 297 (67.0%) experienced GS upgrading postoperatively. PI-RADSv2 scores 1 to 3 and 4 to 5 were identified in 157 (25.4%) and 286 (64.6%) patients, respectively, and the rate of GS upgrading was 54.1% and 74.1%, respectively (P < .001). In multivariate analysis, prostate-specific antigen density > 0.16 ng/mL, number of positive cores ≥ 2, maximum percentage of cancer per core > 20, and PI-RADSv2 score 4 to 5 were independent predictors influencing GS upgrading (each P < .05). When predictive accuracies of multivariate models with or without PI-RADSv2 were compared, the model including PI-RADSv2 was shown to have significantly higher accuracy (area under the curve, 0.729 vs. 0.703; P = .041).
Use of PI-RADSv2 is an independent predictor of postoperative GS upgrading and increases the predictive accuracy of GS upgrading. PI-RADSv2 might be used as a preoperative imaging tool to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.
本研究的目的是探讨前列腺影像报告和数据系统第 2 版（PI-RADSv2）对经活检证实为前列腺癌 Gleason 评分 6 级（GS）患者术后 GS 升级的预测作用。
我们回顾性分析了 2011 年 1 月至 2013 年 12 月期间因经活检证实为 GS 6 级前列腺癌而接受磁共振成像（MRI）和根治性前列腺切除术的 443 例患者。检查了术前临床变量和病理 GS，并使用 PI-RADSv2 评估了所有 MRI 结果。使用受试者工作特征曲线比较了包含或不包含 PI-RADSv2 的多变量逻辑回归模型的预测准确性。
在总共 443 例患者中，297 例（67.0%）术后出现 GS 升级。PI-RADSv2 评分 1-3 分和 4-5 分分别在 157 例（25.4%）和 286 例（64.6%）患者中检出，GS 升级率分别为 54.1%和 74.1%（P<0.001）。多变量分析中，前列腺特异性抗原密度>0.16ng/mL、阳性核心数≥2、每核心最大癌症百分比>20 以及 PI-RADSv2 评分 4-5 分是影响 GS 升级的独立预测因素（各 P<0.05）。当比较包含或不包含 PI-RADSv2 的多变量模型的预测准确性时，包含 PI-RADSv2 的模型显示出更高的准确性（曲线下面积，0.729 比 0.703；P=0.041）。
PI-RADSv2 的使用是术后 GS 升级的独立预测因素，并提高了 GS 升级的预测准确性。PI-RADSv2 可作为术前影像学工具，用于确定风险分类，并帮助患者就治疗决策和疾病预后做出决策。
