前列腺影像报告和数据系统 2 版联合国际泌尿病理学会分级预测前列腺癌根治术后生化复发。

Biparametric Prostate Imaging Reporting and Data System version2 and International Society of Urological Pathology Grade Predict Biochemical Recurrence after Radical Prostatectomy.

机构信息

Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.

出版信息

Clin Genitourin Cancer. 2018 Aug;16(4):e817-e829. doi: 10.1016/j.clgc.2018.02.011. Epub 2018 Feb 24.

DOI:10.1016/j.clgc.2018.02.011

PMID:29576444

Abstract

BACKGROUND

We retrospectively assessed the clinical significance of the Prostate Imaging Reporting and Data System (PI-RADS), version 2, criteria based on biparametric magnetic resonance imaging (bp-MRI), together with the International Society of Urological Pathology (ISUP) grade, for predicting biochemical recurrence (BCR) after radical prostatectomy.

MATERIALS AND METHODS

The data from 126 patients who had undergone radical prostatectomy were retrospectively analyzed. The prognostic significance of the PI-RADS v2 score based on bp-MRI was assessed with other clinical factors, including the ISUP grade. We defined a positive PI-RADS and ISUP score as ≥ 4 and ≥ 3, respectively. Statistical analysis was performed using Cox proportional hazard models, logistic regression analysis, and the Kaplan-Meier method.

RESULTS

The median age and median prostate-specific antigen level were 66 years and 7.96 ng/mL, respectively. The number of positive PI-RADS scores was 106 (84.1%) and the number of positive ISUP grade scores was 71 (56.3%). PI-RADS ≥ 4 (P = .0031) and ISUP ≥ 3 (P = .070) were the 2 independent prognostic factors predictive of BCR. A positive PI-RADS score was related to tumor volume (P = .014), and a positive ISUP score was related to prostate-specific antigen level (P = .043), extraprostatic extension (P = .029), and Gleason upgrading (P < .0001). After stratifying patients into risk groups according to PI-RADS and ISUP positivity, the poor-risk group (PI-RADS and ISUP grade positive) showed significantly worse BCR-free survival compared with that of the favorable- and intermediate-risk groups (P < .0001), with a median survival difference of 21 months.

CONCLUSION

Biparametric PI-RADS v2 and ISUP grade criteria predicted for BCR after radical prostatectomy. PI-RADS v2 combined with the ISUP grade might be helpful in choosing the treatment modality of patients with localized prostate cancer.

摘要

背景

我们回顾性评估了基于双参数磁共振成像（bp-MRI）的前列腺影像报告和数据系统（PI-RADS）版本 2 标准与国际泌尿病理学会（ISUP）分级联合对前列腺根治性切除术（RP）后生化复发（BCR）的临床意义。

材料和方法

回顾性分析 126 例行 RP 患者的数据。使用 Cox 比例风险模型、逻辑回归分析和 Kaplan-Meier 方法评估基于 bp-MRI 的 PI-RADS v2 评分与其他临床因素（包括 ISUP 分级）的预测意义。我们将阳性 PI-RADS 和 ISUP 评分定义为≥4 和≥3。

结果

中位年龄和中位前列腺特异性抗原（PSA）水平分别为 66 岁和 7.96ng/ml。PI-RADS 评分阳性 106 例（84.1%），ISUP 分级阳性 71 例（56.3%）。PI-RADS≥4（P=.0031）和 ISUP≥3（P=.070）是预测 BCR 的 2 个独立预后因素。PI-RADS 评分阳性与肿瘤体积有关（P=.014），ISUP 评分阳性与 PSA 水平（P=.043）、前列腺外侵犯（P=.029）和 Gleason 升级（P<0.0001）有关。根据 PI-RADS 和 ISUP 评分将患者分为风险组后，高危组（PI-RADS 和 ISUP 分级阳性）的 BCR 无复发生存率明显差于低危和中危组（P<0.0001），中位生存差异为 21 个月。