多参数 MRI、Partin 表、纪念斯隆-凯特琳癌症中心列线图和 CAPRA 评分在预测接受根治性前列腺切除术患者前列腺外癌中的头对头比较。
Head-to-head comparison between multiparametric MRI, the partin tables, memorial sloan kettering cancer center nomogram, and CAPRA score in predicting extraprostatic cancer in patients undergoing radical prostatectomy.
机构信息
Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, Udine, Italy.
Urology Unit, "S. Maria della Misericordia" University Hospital, Udine, Italy.
出版信息
J Magn Reson Imaging. 2019 Nov;50(5):1604-1613. doi: 10.1002/jmri.26743. Epub 2019 Apr 7.
BACKGROUND
It is unclear whether clinical models including the Partin tables (PT), the Memorial Sloan Kettering Cancer Center nomogram (MSKCCn), and the cancer of the prostate risk assessment (CAPRA) can benefit from incorporating multiparametric magnetic resonance imaging (mpMRI) when staging prostate cancer (PCa).
PURPOSE
To compare the accuracy of clinical models, mpMRI, and mpMRI plus clinical models in predicting stage ≥pT3 of PCa.
STUDY TYPE
Prospective monocentric cohort study.
POPULATION
Seventy-three patients who underwent radical prostatectomy between 2016-2018.
FIELD STRENGTH/SEQUENCE: 3.0T using turbo spin echo (TSE) imaging, single-shot echoplanar diffusion-weighted imaging, and T -weighted high-resolution-isotropic-volume-examination (THRIVE) contrast-enhanced imaging.
ASSESSMENT
We calculated the probability of extraprostatic extension (EPE) using the PT and MSKCC, as well as the CAPRA score. Three readers with 2-8 years of experience in mpMRI independently staged PCa on imaging.
STATISTICAL TESTS
Receiver operating characteristics analysis and logistic regression analysis to investigate the per-patient accuracy of mpMRI vs. clinical models vs. mpMRI plus clinical models in predicting stage ≥pT3. The alpha level was 0.05.
RESULTS
Median probability for EPE and MSKCCn was 27.3% and 47.0%, respectively. Median CAPRA score was 3. Stage ≥pT3 occurred in 32.9% of patients. Areas under the curve (AUCs) were 0.62 for PT, 0.62 for MSKCCn, 0.64 for CAPRA, and 0.73-0.75 for mpMRI (readers 1-3) (P > 0.05 for all comparisons). Compared with mpMRI, the combination of mpMRI with PT or MSKCCn provided lower AUCs (P > 0.05 for all the readers), while the combination with CAPRA provided significantly higher (P < 0.05) AUCs in the case of readers 1 and 3. On multivariable analysis, mpMRI by reader 1 was the only independent predictor of stage ≥pT3 (odds ratio 7.40). DATA CONCLUSION: mpMRI was more accurate than clinical models and mpMRI plus clinical models in predicting stage ≥pT3, except for the combination of mpMRI and CAPRA in two out of three readers.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1604-1613.
背景
目前尚不清楚在对前列腺癌（PCa）进行分期时，包括前列腺特定抗原（PSA）、前列腺癌危险指数（CAPRA）评分在内的临床模型是否能从多参数磁共振成像（mpMRI）中获益。
目的
比较临床模型、mpMRI 及两者联合在预测 PCa 临床分期≥pT3 中的准确性。
研究类型
前瞻性单中心队列研究。
人群
73 例 2016-2018 年期间接受根治性前列腺切除术的患者。
磁场强度/序列：3.0T 采用 turbo 自旋回波（TSE）成像、单次激发平面回波扩散加权成像和 T1 加权高分辨率各向同性容积激发（THRIVE）对比增强成像。
评估
使用前列腺特定抗原（PSA）和 Memorial Sloan Kettering 癌症中心（MSKCC）计算前列腺外延伸（EPE）的概率，以及 CAPRA 评分。3 名具有 2-8 年 mpMRI 经验的阅片者独立对 MRI 上的 PCa 进行分期。
统计学检验
采用受试者工作特征曲线（ROC）分析和逻辑回归分析，以评估 mpMRI 与临床模型相比，在预测临床分期≥pT3 方面的个体患者准确性。采用α水平 0.05。
结果
EPE 和 MSKCCn 的中位数概率分别为 27.3%和 47.0%。CAPRA 评分中位数为 3。32.9%的患者临床分期≥pT3。ROC 曲线下面积（AUC）为 0.62 （PT）、0.62 （MSKCCn）、0.64 （CAPRA）和 0.73-0.75（mpMRI 阅读者 1-3）（所有比较的 P>0.05）。与 mpMRI 相比，mpMRI 联合 PT 或 MSKCCn 提供的 AUC 较低（所有阅读者的 P>0.05），而与 CAPRA 联合提供的 AUC 较高（阅读者 1 和 3，P<0.05）。多变量分析显示，阅读者 1 的 mpMRI 是预测临床分期≥pT3 的唯一独立预测因子（优势比 7.40）。
数据结论
mpMRI 在预测临床分期≥pT3 方面优于临床模型和 mpMRI 联合临床模型，除了在 3 名阅读者中的 2 名中，mpMRI 与 CAPRA 联合的预测效果。
证据水平
2 技术功效：2 级。J. 磁共振成像 2019;50:1604-1613.
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