Glaser Zachary A, Gordetsky Jennifer B, Bae Sejong, Nix Jeffrey W, Porter Kristin K, Rais-Bahrami Soroush
Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
Urol Oncol. 2019 Dec;37(12):970-975. doi: 10.1016/j.urolonc.2019.08.006. Epub 2019 Sep 5.
The Memorial Sloan Kettering Cancer Center (MSKCC) Preprostatectomy nomogram is a widely used resource that integrates clinical factors to predict the likelihood of adverse pathology at radical prostatectomy. Adoption of magnetic resonance imaging targeted biopsy (TB) permits optimized detection of clinically-significant cancer over systematic biopsy (SB) alone. We aim to evaluate the prognostic utility of the MSKCC Preprostatectomy nomogram with TB pathology results.
Men who underwent SB and magnetic resonance imaging TB who later underwent radical prostatectomy at our institution were included. Patient information was entered into the MSKCC Preprostatectomy nomogram using 5 biopsy reporting schemes with TB reported by both individual core (IC) and aggregate group (AG) methods. The likelihood of extraprostatic extension, seminal vesicle invasion, and lymph node involvement as predicted by the nomogram for each biopsy reporting schema were compared to radical prostatectomy pathology.
We identified 63 men from January 2014 to November 2017. On receiver operating characteristic analysis, IC-TB, AG-TB, SB plus IC-TB, and SB plus AG-TB exhibited similar, if not improved, area under the curve compared to SB alone in predicting extraprostatic extension (0.671, 0.674, 0.658, and 0.6613 vs. 0.6085). This was similarly observed for seminal vesicle invasion prediction using SB plus IC-TB compared to SB alone (0.727 vs. 0.733). For lymph node involvement, superior but nonsignificant area under the curve was observed for AG-TB (0.647) compared to IC-TB (0.571) and SB alone (0.524) CONCLUSIONS: Using TB pathology results either alone or combined with SB pathology results as input to the MSKCC Preprostatectomy nomogram appears comparable for prognosticating adverse pathology on radical prostatectomy compared to SB alone, but robust validation is warranted prior to adoption into clinical practice.
纪念斯隆凯特琳癌症中心（MSKCC）前列腺切除术前列线图是一种广泛使用的资源，它整合临床因素以预测根治性前列腺切除术中出现不良病理结果的可能性。采用磁共振成像靶向活检（TB）相较于单纯系统活检（SB）能更优化地检测出具有临床意义的癌症。我们旨在评估MSKCC前列腺切除术前列线图结合TB病理结果的预后效用。
纳入在我们机构接受了SB和磁共振成像TB且随后接受根治性前列腺切除术的男性患者。使用5种活检报告方案将患者信息录入MSKCC前列腺切除术前列线图，其中TB通过个体核心（IC）和汇总组（AG）方法报告。将列线图针对每种活检报告模式预测的前列腺外扩展、精囊侵犯和淋巴结受累的可能性与根治性前列腺切除术后的病理结果进行比较。
我们确定了2014年1月至2017年11月期间的63名男性患者。在接受者操作特征分析中，与单独使用SB相比，IC-TB、AG-TB、SB加IC-TB以及SB加AG-TB在预测前列腺外扩展时表现出相似（即便没有改善）的曲线下面积（分别为0.671、0.674、0.658和0.6613，而单独使用SB为0.6085）。在使用SB加IC-TB预测精囊侵犯时与单独使用SB相比也有类似情况（分别为0.727和0.733）。对于淋巴结受累，与IC-TB（0.571）和单独使用SB（0.524）相比，AG-TB的曲线下面积更高但无显著差异（0.647）。结论：单独使用TB病理结果或与SB病理结果结合作为输入纳入MSKCC前列腺切除术前列线图，在预测根治性前列腺切除术中的不良病理结果方面与单独使用SB相比似乎相当，但在应用于临床实践之前需要进行有力的验证。
