Leong Joon Yau, Herrera-Caceres Jaime O, Goldberg Hanan, Tham Elwin, Teplitsky Seth, Gomella Leonard G, Fleshner Neil E, Lallas Costas D, Trabulsi Edouard J, Chandrasekar Thenappan
Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia PA, USA.
Division of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, Canada.
Ther Adv Urol. 2019 Oct 13;11:1756287219882809. doi: 10.1177/1756287219882809. eCollection 2019 Jan-Dec.
We examine the practical application of multiparametric MRI (mpMRI) prostate biopsy data using established pre-RP nomograms and its potential implications on RP intraoperative decision-making. We hypothesize that current nomograms are suboptimal in predicting outcomes with mpMRI targeted biopsy (TBx) data.
Patients who underwent mpMRI-based TBx prior to RP were assessed using the MSKCC and Briganti nomograms with the following iterations: (1) Targeted (T) (targeted only), (2) Targeted and Systematic (TS) and (3) Targeted Augmented (TA) (targeted core data; assumed negative systematic cores for 12 total cores). Nomogram outcomes, lymph node involvement (LNI), extracapsular extension (ECE), organ-confined disease (OCD), seminal vesicle invasion (SVI), were compared across iterations. Clinically significant impact on management was defined as a change in LNI risk above or below 2% (Δ2) or 5% (Δ5).
A total of 217 men met inclusion criteria. Overall, the TA iteration had more conservative nomogram outcomes than the T. Moreover, TA better predicted RP pathology for all four outcomes when compared with the T. In the entire cohort, Δ2 and Δ5 were 16.6-25.8% and 20.3-39.2%, respectively. In the subset of 190 patients with targeted and systematic cores, TA was a better approximation of TS outcomes than T in 71% (MSKCC) and 82% (Briganti) of patients.
In established pre-RP nomograms, mpMRI-based TBx often yield variable and discordant results when compared with systematic biopsies. Future nomograms must better incorporate mpMRI TBx core data. In the interim, augmenting TBx data may serve to bridge the gap.
我们使用已建立的前列腺癌根治术（RP）前列线图来研究多参数磁共振成像（mpMRI）前列腺活检数据的实际应用及其对RP术中决策的潜在影响。我们假设当前列线图在预测mpMRI靶向活检（TBx）数据的结果方面并非最优。
对在RP前接受基于mpMRI的TBx的患者，使用纪念斯隆凯特琳癌症中心（MSKCC）和布里甘蒂列线图进行如下迭代评估：（1）靶向（T）（仅靶向），（2）靶向和系统（TS），以及（3）靶向增强（TA）（靶向核心数据；假设12个总核心的系统核心为阴性）。比较各迭代之间的列线图结果、淋巴结受累（LNI）、包膜外侵犯（ECE）、器官局限性疾病（OCD）、精囊侵犯（SVI）。对管理的临床显著影响定义为LNI风险变化高于或低于2%（Δ2）或5%（Δ5）。
共有217名男性符合纳入标准。总体而言，TA迭代的列线图结果比T更保守。此外，与T相比，TA在所有四个结果上对RP病理的预测更好。在整个队列中，Δ2和Δ5分别为16.6 - 25.8%和20.3 - 39.2%。在190名有靶向和系统核心的患者子集中，在71%（MSKCC）和82%（布里甘蒂）的患者中，TA比T更接近TS结果。
在已建立的RP前列线图中，与系统活检相比，基于mpMRI的TBx通常会产生可变且不一致的结果。未来的列线图必须更好地纳入mpMRI TBx核心数据。在此期间，增加TBx数据可能有助于弥合差距。
