Wei Cheng, Zhang Yilong, Malik Hamza, Zhang Xinyu, Alqahtani Saeed, Upreti Dilip, Szewczyk-Bieda Magdalena, Lang Stephen, Nabi Ghulam
Division of Imaging Science and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom.
School of Science and Engineering, University of Dundee, Dundee, United Kingdom.
Front Oncol. 2019 Jul 9;9:572. doi: 10.3389/fonc.2019.00572. eCollection 2019.
To determine the prognostic significance of tissue stiffness measurement using transrectal ultrasound shear wave elastography in predicting biochemical recurrence following radical prostatectomy for clinically localized prostate cancer. Eligible male patients with clinically localized prostate cancer and extraperitoneal laparoscopic radical prostatectomy between November 2013 and August 2017 were retrospectively selected. Information of potential biochemical recurrence predictors, including imaging (ultrasound shear wave elastography and magnetic resonance imaging), clinicopathological characteristics, and preoperative prostate specific antigen (PSA) levels were obtained. Recurrence-free survival (Kaplan-Meier curve) and a multivariate model were constructed using Cox regression analysis to evaluate the impact of shear wave elastography as a prognostic marker for biochemical recurrence. Patients experienced biochemical recurrence in an average of 26.3 ± 16.3 months during their follow-up. A cutoff of 144.85 kPa for tissue stiffness measurement was estimated for recurrence status at follow-up with a sensitivity of 74.4% and a specificity of 61.7%, respectively ( < 0.05). In univariate analysis, shear wave elastography performed well in all preoperative factors compared to biopsy Gleason Score, PSA and magnetic resonance imaging; in multivariate analysis with postoperative pathological factors, shear wave elastography was statistically significant in predicting postoperative biochemical recurrence, which improved the C-index of predictive nomogram significantly (0.74 vs. 0.70, < 0.05). The study revealed that quantitative ultrasound shear wave elastography-measured tissue stiffness was a significant imaging marker that enhanced the predictive ability with other clinical and histopathological factors in prognosticating postoperative biochemical recurrence following radical prostatectomy for clinically localized prostate cancer.
为了确定经直肠超声剪切波弹性成像测量组织硬度在预测临床局限性前列腺癌根治性前列腺切除术后生化复发方面的预后意义。回顾性选取了2013年11月至2017年8月间患有临床局限性前列腺癌并接受腹膜外腹腔镜根治性前列腺切除术的符合条件的男性患者。获取了潜在生化复发预测指标的信息，包括影像学检查（超声剪切波弹性成像和磁共振成像）、临床病理特征以及术前前列腺特异性抗原（PSA）水平。采用Cox回归分析构建无复发生存率（Kaplan-Meier曲线）和多变量模型，以评估剪切波弹性成像作为生化复发预后标志物的影响。患者在随访期间平均26.3±16.3个月出现生化复发。估计组织硬度测量的临界值为144.85 kPa，用于随访时的复发状态，敏感性和特异性分别为74.4%和61.7%（<0.05）。在单变量分析中，与活检Gleason评分、PSA和磁共振成像相比，剪切波弹性成像在所有术前因素中表现良好；在与术后病理因素的多变量分析中，剪切波弹性成像在预测术后生化复发方面具有统计学意义，显著提高了预测列线图的C指数（0.74对0.70，<0.05）。该研究表明，定量超声剪切波弹性成像测量的组织硬度是一个重要的影像学标志物，可增强与其他临床和组织病理学因素一起预测临床局限性前列腺癌根治性前列腺切除术后生化复发的能力。
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