Wang Yan, Wu Guangyu, Fan Liancheng, Pan Jiahua, Gong Yiming, Fei Xiaochen, Du Xinxing, Zhu Yinjie, Xue Wei
Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Imaging, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Prostate. 2021 Jun;81(8):463-468. doi: 10.1002/pros.24126. Epub 2021 Apr 6.
To establish the prognostic nomogram for locally advanced prostate cancer (LAPC) patients treated by radical prostatectomy (RP) based on clinical and multiparametric-MRI (mp-MRI) metrics.
One hundred and twenty-one patients diagnosed with LAPC were included in this study. They were all examined by mp-MRI within one week before surgery and treated by RP (36 with RP alone, 48 with neoadjuvant hormonal therapy (NHT) and 37 with neoadjuvant chemohormonal therapy (NCHT)). The biochemical progression-free survival (bPFS) was analyzed by Kaplan-Meier method. Univariate and multivariate analysis were used to determine prognostic factors that were related with bPFS. The prognostic nomogram was established by factors that were significant in multivariate analyses.
The median bPFS had significant difference in the subgroup of treatment (RP alone: 2 [0.00-5.04] vs. NHT: 9.3 [6.746-11.854] vs. NCHT: 11.17 [0.000-25.075] months [Log rank p < .001]), the subgroup of hyperintensity within prostate in DWI (negative: 15.97 [11.202-20.731] vs. positive: 5.2 [2.952-7.448] months [Log rank p < .001]) and the subgroup of pelvic lymph node metastasis (negative: 10.2 [8.404-11.996] vs. unilateral: 4.43 [0.000-11.086] vs. Bilateral: 1.83 [0.636~3.031] [Log rank p < .001]). The method of treatment (hazards ratio [HR], 0.566; 95% confidence interval [CI], 0.356-0.899; p = .016), hyperintensity within prostate in DWI (HR, 2.539; 95% CI, 1.349-4.779; p = .004) and the metastasis burden of pelvic lymph node (HR, 2.492; 95% CI, 1.645-3.777; p < .001) were identified as independent predictors with significance in multivariable Cox regression analysis. The nomogram was established based on these three factors.
We established a nomogram based on three significant prognosis factors including the neoadjuvant therapeutic schedule, hyperintensity within prostate in DWI and the metastasis burden of pelvic lymph nodes, which were associated with the clinical outcomes in LAPC patients after surgery.
基于临床和多参数磁共振成像（mp-MRI）指标，为接受根治性前列腺切除术（RP）的局部晚期前列腺癌（LAPC）患者建立预后列线图。
本研究纳入121例诊断为LAPC的患者。他们均在手术前一周内接受mp-MRI检查，并接受RP治疗（36例单纯RP，48例新辅助激素治疗（NHT），37例新辅助化疗联合激素治疗（NCHT））。采用Kaplan-Meier法分析生化无进展生存期（bPFS）。单因素和多因素分析用于确定与bPFS相关的预后因素。通过多因素分析中有显著意义的因素建立预后列线图。
治疗亚组的中位bPFS有显著差异（单纯RP：2[0.00 - 5.04]个月 vs. NHT：9.3[6.746 - 11.854]个月 vs. NCHT：11.17[0.000 - 25.075]个月[Log秩检验p <.001]），DWI序列中前列腺内高信号亚组（阴性：15.97[11.202 - 20.731]个月 vs. 阳性：5.2[2.952 - 7.448]个月[Log秩检验p <.001]）以及盆腔淋巴结转移亚组（阴性：10.2[8.404 - 11.996]个月 vs. 单侧：4.43[0.000 - 11.086]个月 vs. 双侧：1.83[0.636 - 3.031]个月[Log秩检验p <.001]）。治疗方法（风险比[HR]，0.566；95%置信区间[CI]，0.356 - 0.899；p = 0.016）、DWI序列中前列腺内高信号（HR，2.539；95%CI，1.349 - 4.779；p = 0.004）以及盆腔淋巴结转移负荷（HR，2.492；95%CI，1.645 - 3.777；p <.001）在多变量Cox回归分析中被确定为具有显著意义的独立预测因素。基于这三个因素建立了列线图。
我们基于新辅助治疗方案、DWI序列中前列腺内高信号以及盆腔淋巴结转移负荷这三个显著的预后因素建立了列线图，这些因素与LAPC患者术后的临床结局相关。
