University of Chicago, Department of Radiation and Cellular Oncology, Chicago, IL.
University of Chicago, Department of Radiology, Chicago, IL.
Urol Oncol. 2020 Jun;38(6):600.e1-600.e8. doi: 10.1016/j.urolonc.2019.12.015. Epub 2020 Jan 15.
Novel methods of risk stratification are needed for men with prostate cancer. The Prostate Imaging Reporting and Data System (PI-RADS) uses multiparametric MRI (mpMRI) to assign a score indicating the likelihood of clinically significant prostate cancer. We evaluated pretreatment mpMRI findings, including PI-RADS score, as a marker for outcome in patients treated with primary radiation therapy (RT).
One hundred and twenty-three men, 64% and 36% of whom had National Comprehensive Cancer Network (NCCN) intermediate-risk and high-risk disease, respectively, underwent mpMRI prior to RT. PI-RADS score and size of the largest nodule were analyzed with respect to freedom from biochemical failure (FFBF) and freedom from distant metastasis.
A PI-RADS score of ≤3, 4, or 5 was defined in 7%, 49%, and 44%; with a median nodule size of 0, 8, and 18 mm, respectively (P < 0.001). Median follow-up was 67 months. Men with PI-RADS ≤ 3, 4, or 5 disease had 7-year FFBF of 100%, 92%, and 65% (P = 0.002), and a 7-year freedom from distant metastasis of 100%, 100%, and 82%, respectively (P = 0.014). PI-RADS (Hazard Ratio 5.4 for PI-RADS 5 vs. 4, P = 0.006) remained associated with FFBF when controlling for NCCN risk category (P = 0.063) and receipt of androgen deprivation therapy (P = 0.535). Nodule size was also associated with FFBF (Hazard Ratio 1.08 per mm, P < 0.001) after controlling for NCCN risk category (P = 0.156) and receipt of androgen deprivation therapy (P = 0.776).
mpMRI findings, including PI-RADS score and nodule size, may improve risk stratification in men treated with primary RT.
需要新的方法对前列腺癌患者进行风险分层。前列腺成像报告和数据系统（PI-RADS）使用多参数 MRI（mpMRI）对临床显著前列腺癌的可能性进行评分。我们评估了预处理 mpMRI 结果，包括 PI-RADS 评分，作为接受原发性放射治疗（RT）的患者的预后标志物。
123 名男性患者，分别有 64%和 36%的患者患有国家综合癌症网络（NCCN）中危和高危疾病，在 RT 前接受了 mpMRI。PI-RADS 评分和最大结节的大小与生化无失败（FFBF）和远处转移无自由相关。
PI-RADS 评分≤3、4 或 5 的定义分别为 7%、49%和 44%；中位数结节大小分别为 0、8 和 18mm（P<0.001）。中位随访时间为 67 个月。PI-RADS 评分≤3、4 或 5 的男性患者 7 年 FFBF 分别为 100%、92%和 65%（P=0.002），7 年远处转移无分别为 100%、100%和 82%（P=0.014）。PI-RADS（PI-RADS 5 与 4 相比，风险比 5.4，P=0.006）在控制 NCCN 风险类别（P=0.063）和接受雄激素剥夺治疗（P=0.535）时仍然与 FFBF 相关。控制 NCCN 风险类别（P=0.156）和接受雄激素剥夺治疗（P=0.776）后，结节大小也与 FFBF 相关（每毫米 1.08 的风险比，P<0.001）。
mpMRI 结果，包括 PI-RADS 评分和结节大小，可能会改善接受原发性 RT 治疗的男性患者的风险分层。
