在 MRI 和靶向活检时代前列腺切除术的不良病理风险；重新思考中危前列腺癌患者的主动监测。
Risk of adverse pathology at prostatectomy in the era of MRI and targeted biopsies; rethinking active surveillance for intermediate risk prostate cancer patients.
机构信息
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
出版信息
Urol Oncol. 2021 Oct;39(10):729.e1-729.e6. doi: 10.1016/j.urolonc.2021.02.018. Epub 2021 Mar 16.
PURPOSE
Men with intermediate risk (IR) prostate cancer (CaP) are often excluded from active surveillance (AS) due to higher rates of adverse pathology (AP). We determined our rate of AP in men who underwent multiparametric MRI (MpMRI) with combined biopsy (CB) consisting of targeted biopsy (TB) and systematic biopsy (SB) prior to radical prostatectomy (RP).
METHODS
A retrospective review was conducted of men with Gleason Grade Group (GG) 2 disease who underwent RP after SB alone or after preoperative MRI with CB. AP was defined as either pathologic stage T3a (AP ≥ T3a) or pathologic stage T3b (AP ≥ T3b) and/or GG upgrading. Rates of AP were determined for both groups and those who fit the National Comprehensive Cancer Network (NCCN) definition of favorable IR (FIR) or the low volume IR (LVIR) criteria. Multivariable logistic regression was used to determine predictive factors.
RESULTS
The overall rate of AP ≥ T3b was 21.2% in the SB group vs. 8.6% in the MRI with CB group, P = 0.006. This rate was lowered to 6.8% and 5.6% when men met the definition of NCCN FIR or LVIR, respectively. Suspicion for extraprostatic extension (EPE) (OR 7.65, 95% CI 1.77-33.09, P = 0.006) and positive cores of GG 2 on SB (OR 1.43, 95% CI 1.05-1.96, P = 0.023) were significant for predicting AP ≥ T3b.
CONCLUSIONS
Rates of AP at RP after MRI with CB are lower than studies prior to the adoption of this technology, suggesting that more men with IR disease may be considered for AS. However, increasing cores positive on SB and MRI findings suggestive of EPE remain unsafe.
目的
由于不良病理（AP）发生率较高，中危（IR）前列腺癌（CaP）患者通常被排除在主动监测（AS）之外。我们确定了在接受多参数 MRI（MpMRI）联合靶向活检（TB）和系统活检（SB）的男性中，AP 的发生率，然后对这些男性进行根治性前列腺切除术（RP）。
方法
对仅接受 SB 或术前 MRI 联合 CB 治疗后接受 RP 的 Gleason 分级组（GG）2 疾病男性进行回顾性分析。AP 定义为病理分期 T3a（AP≥T3a）或病理分期 T3b（AP≥T3b）和/或 GG 升级。确定了两组的 AP 发生率以及符合国家综合癌症网络（NCCN）有利 IR（FIR）或低体积 IR（LVIR）标准的患者的 AP 发生率。多变量逻辑回归用于确定预测因素。
结果
在 SB 组中，AP≥T3b 的总体发生率为 21.2%，而在 MRI 联合 CB 组中为 8.6%，P=0.006。当男性符合 NCCN FIR 或 LVIR 定义时，该比率分别降低至 6.8%和 5.6%。对 MRI 联合 CB 组，怀疑存在前列腺外延伸（EPE）（OR 7.65，95%CI 1.77-33.09，P=0.006）和 SB 上 GG2 阳性核心数（OR 1.43，95%CI 1.05-1.96，P=0.023）是预测 AP≥T3b 的显著因素。
结论
MRI 联合 CB 后 RP 的 AP 发生率低于该技术应用前的研究，这表明更多的 IR 疾病患者可能被考虑接受 AS。然而，SB 阳性核心数增加和 MRI 发现提示 EPE 仍然是不安全的。
Zotero 插件