磁共振成像上肿瘤体积指数作为根治性前列腺切除术后临床和病理结局的预测指标。
Index tumor volume on MRI as a predictor of clinical and pathologic outcomes following radical prostatectomy.
机构信息
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 3-1621 NW, Bethesda, MD, 20814, USA.
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
出版信息
Int Urol Nephrol. 2019 Aug;51(8):1349-1355. doi: 10.1007/s11255-019-02168-4. Epub 2019 May 16.
PURPOSE
Index tumor volume (ITV) measured on radical prostatectomy (RP) specimens has been shown to be associated with adverse pathologic and oncologic outcomes. We evaluate the value of ITV calculated from prostate multiparametric MRI (mpMRI) in predicting adverse clinical and pathologic outcomes.
MATERIALS AND METHODS
Data from a prospectively maintained, single-institution database were analyzed for patients who underwent mpMRI prior to RP (2007-2016). Index tumor was defined as a T2-visible lesion with the longest diameter. Adverse pathologic outcomes were extraprostatic extension (EPE), lymph node invasion (LNI), seminal vesicle invasion (SVI), and positive margins (PM). Logistic and Cox proportional hazard regression were used to assess associations with adverse pathology and biochemical recurrence (BCR), respectively.
RESULTS
Of the 455 patients included, EPE, LNI, SVI and PM were present in 23.5%, 6.2%, 5.5% and 15.7% patients, respectively. Patients with adverse pathologic outcomes had larger median ITV. ITV was found to be an independent predictor of EPE (OR 1.22, p = 0.010), LNI (OR 1.39, p = 0.001), and SVI (OR 1.28, p = 0.009), but not PM (OR 1.03, p = 0.522). Combination of ITV and PSA was found to have predictive ability comparable to that of modified Partin tables (EPE:ITV + PSA = 0.71 vs. Partin = 0.71; LNI:ITV + PSA = 0.92 vs. Partin = 0.90, SVI:ITV + PSA = 0.78 vs. Partin = 0.82). 5 year BCR-free survival (median follow-up 24.9 months) was higher for patients with ITV < 2 cc (84.1% vs. 58.5%, p = 0.001). However, ITV was not found to be an independent predictor of BCR (HR 1.69, p = 0.130).
CONCLUSIONS
We demonstrate that ITV measured on mpMRI is a predictor of adverse pathologic and clinical outcomes and can aid in preoperative risk assessment.
目的
根治性前列腺切除术（RP）标本上测量的肿瘤指数体积（ITV）与不良病理和肿瘤学结果相关。我们评估从前列腺多参数 MRI（mpMRI）计算得出的 ITV 预测不良临床和病理结局的价值。
材料与方法
对 2007 年至 2016 年间接受 mpMRI 检查的患者，对来自前瞻性维护的单中心数据库的数据进行了分析。指数肿瘤定义为具有最长直径的 T2 可见病变。不良病理结果包括前列腺外扩展（EPE）、淋巴结侵犯（LNI）、精囊侵犯（SVI）和阳性切缘（PM）。使用逻辑和 Cox 比例风险回归分别评估与不良病理和生化复发（BCR）的关联。
结果
455 例患者中，EPE、LNI、SVI 和 PM 分别存在于 23.5%、6.2%、5.5%和 15.7%的患者中。有不良病理结果的患者 ITV 中位数更大。ITV 是 EPE（OR 1.22，p=0.010）、LNI（OR 1.39，p=0.001）和 SVI（OR 1.28，p=0.009）的独立预测因子，但不是 PM（OR 1.03，p=0.522）。发现 ITV 与 PSA 的组合具有与改良的帕丁（Partin）表相当的预测能力（EPE：ITV+PSA=0.71 vs. Partin=0.71；LNI：ITV+PSA=0.92 vs. Partin=0.90，SVI：ITV+PSA=0.78 vs. Partin=0.82）。5 年 BCR 无复发生存率（中位随访 24.9 个月）较高的患者 ITV<2cc（84.1%比 58.5%，p=0.001）。然而，ITV 并不是 BCR 的独立预测因子（HR 1.69，p=0.130）。
结论
我们证明，mpMRI 上测量的 ITV 是不良病理和临床结果的预测因子，并有助于术前风险评估。
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