Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2021 Apr;205(4):1055-1062. doi: 10.1097/JU.0000000000001474. Epub 2020 Nov 18.
We investigated whether T2-weighted magnetic resonance imaging findings could improve upon established prognostic indicators of metastatic disease and prostate cancer specific survival.
For a cohort of 3,406 consecutive men who underwent prostate magnetic resonance imaging before prostatectomy (2,160) or radiotherapy (1,246) between 2001 and 2006, T2-weighted magnetic resonance imaging exams were retrospectively interpreted and categorized as I) no focal suspicious lesion, II) organ confined focal lesion, III) focal lesion with extraprostatic extension or IV) focal lesion with seminal vesicle invasion. Clinical risk was recorded based on European Association of Urology (EAU) guidelines and the Cancer of the Prostate Risk Assessment (CAPRA) scoring system. Survival probabilities and c-indices were estimated using Cox models and inverse probability censoring weights, respectively.
The median followup was 10.8 years (IQR 8.6-13.0). Higher magnetic resonance imaging categories were associated with a higher likelihood of developing metastases (HR 3.5-18.1, p <0.001 for all magnetic resonance imaging categories) and prostate cancer death (HR 3.1-29.7, p <0.001-0.025); these associations were statistically independent of EAU risk categories, CAPRA scores and treatment type (surgery vs radiation). Combining EAU risk or CAPRA scores with magnetic resonance imaging categories significantly improved prognostication of metastases (c-indices: EAU: 0.798, EAU + magnetic resonance imaging: 0.872; CAPRA: 0.808, CAPRA + magnetic resonance imaging: 0.877) and prostate cancer death (c-indices: EAU 0.813, EAU + magnetic resonance imaging: 0.889; CAPRA: 0.814, CAPRA + magnetic resonance imaging: 0.892; p <0.001 for all).
Magnetic resonance imaging findings of localized prostate cancer are associated with clinically relevant long-term oncologic outcomes. Combining magnetic resonance imaging and clinicopathological data results in more accurate prognostication, which could facilitate individualized patient management.
我们研究了 T2 加权磁共振成像（MRI）表现是否可以改善转移性疾病和前列腺癌特异性生存的既定预后指标。
我们对 2001 年至 2006 年间连续 3406 例接受前列腺 MRI 检查的男性（前列腺切除术 2160 例，放疗 1246 例）进行了回顾性分析，将 T2 加权 MRI 检查结果分为 I）无局灶性可疑病变，II）局限性局灶性病变，III）局限性病变伴外生，IV）局限性病变伴精囊侵犯。根据欧洲泌尿外科学会（EAU）指南和前列腺癌风险评估（CAPRA）评分系统记录临床风险。使用 Cox 模型和逆概率 censoring 权重分别估计生存概率和 c 指数。
中位随访时间为 10.8 年（IQR 8.6-13.0）。较高的 MRI 分类与发生转移（HR 3.5-18.1，所有 MRI 分类均 p<0.001）和前列腺癌死亡（HR 3.1-29.7，p<0.001-0.025）的可能性更高相关；这些关联在统计学上独立于 EAU 风险类别、CAPRA 评分和治疗类型（手术与放疗）。将 EAU 风险或 CAPRA 评分与 MRI 分类相结合，显著提高了转移（c 指数：EAU：0.798，EAU+MRI：0.872；CAPRA：0.808，CAPRA+MRI：0.877）和前列腺癌死亡（c 指数：EAU 0.813，EAU+MRI：0.889；CAPRA：0.814，CAPRA+MRI：0.892；p<0.001）的预测能力。
局限性前列腺癌的 MRI 表现与临床相关的长期肿瘤学结局相关。将 MRI 与临床病理数据相结合可实现更准确的预后预测，从而有助于个体化患者管理。
