Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
Prostate Cancer Prostatic Dis. 2019 Dec;22(4):539-545. doi: 10.1038/s41391-019-0136-3. Epub 2019 Feb 27.
Tumor contact length (TCL) is defined as the extent of contact between prostate cancer and the prostatic capsule, and its predictive value for microscopic extraprostatic extension (EPE) has been reported. However, the impact of the zonal origin (anterior or posterior tumor) of the tumor on the diagnosis of EPE is controversial.
We retrospectively analyzed the records of 233 consecutive patients who underwent preoperative MRI and radical prostatectomy. We designated their tumors as anterior or posterior, and evaluated the correlation between the TCL measured by MRI and microscopic EPE in the radical prostatectomy specimen. Then, we created the predicted probability curves for EPE versus TCL for anterior and posterior prostate cancer.
There were 109 patients (47%) with an anterior tumor and 124 patients (53%) with a posterior tumor. Postoperative pathological analysis confirmed pT3 in 18 patients (17%) with an anterior tumor and in 53 patients (43%) with a posterior tumor. Multivariate analysis demonstrated that the zonal origin of the tumor was an independent predictive factor for EPE. We developed separate probability curves of EPE versus TCL for anterior and posterior prostate cancer, which revealed that anterior tumors were less likely to invade the extraprostatic tissues. Among patients whose TCL was 10-20 mm, 9/32 patients (28%) with an anterior tumor had EPE compared with 24/45 patients (53%) with a posterior tumor (p = 0.036). The decision curve of this EPE predictive model had high clinical efficacy.
Our results indicate that anterior tumors have more favorable pathological characteristics than posterior tumors with the same TCL measured by MRI. We constructed two separate predicted probability curves for EPE after discriminating anterior and posterior tumors, which will be useful for decision making in clinical practice.
肿瘤接触长度（TCL）定义为前列腺癌与前列腺包膜之间的接触程度，其对显微镜下的前列腺外扩展（EPE）的预测价值已被报道。然而，肿瘤的区域起源（肿瘤的前侧或后侧）对 EPE 诊断的影响存在争议。
我们回顾性分析了 233 例连续接受术前 MRI 和根治性前列腺切除术的患者的记录。我们将他们的肿瘤指定为前侧或后侧，并评估了 MRI 测量的 TCL 与根治性前列腺切除标本中微观 EPE 的相关性。然后，我们为前侧和后侧前列腺癌创建了 EPE 与 TCL 的预测概率曲线。
109 例患者（47%）为前侧肿瘤，124 例患者（53%）为后侧肿瘤。术后病理分析证实，18 例前侧肿瘤患者（17%）和 53 例后侧肿瘤患者（43%）为 pT3。多变量分析表明，肿瘤的区域起源是 EPE 的独立预测因素。我们为前侧和后侧前列腺癌分别开发了 EPE 与 TCL 的概率曲线，结果表明前侧肿瘤不太可能侵犯前列腺外组织。在 TCL 为 10-20mm 的患者中，32 例前侧肿瘤中有 9 例（28%）有 EPE，而 45 例后侧肿瘤中有 24 例（53%）有 EPE（p=0.036）。该 EPE 预测模型的决策曲线具有较高的临床疗效。
我们的结果表明，在前侧肿瘤与后侧肿瘤具有相同的 MRI 测量 TCL 时，前侧肿瘤具有更有利的病理特征。我们通过区分前侧和后侧肿瘤构建了两个独立的 EPE 预测概率曲线，这将有助于临床实践中的决策。
