Shin Teak Jun, Jung Wonho, Ha Ji Yong, Kim Byung Hoon, Kim Young Hwan
Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea.
Department of Radiology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea.
Prostate Int. 2021 Mar;9(1):6-11. doi: 10.1016/j.prnil.2020.06.001. Epub 2020 Jun 26.
We investigated the relationship between tumor characteristics and visible tumors on magnetic resonance imaging (MRI) and examined the prognosis of tumor detection on MRI compared with no tumor detection in localized prostate cancer.
We reviewed 214 patients with pT2N0M0 prostate cancer who underwent radical prostatectomy between January 2009 and December 2016. All the patients underwent MRI preoperatively. The patients were divided into 2 groups postoperatively: no visible tumor on the MRI group ( = 96, 44.9%) and visible tumor on the MRI group ( = 118, 55.1%). The visible tumor was defined as Prostate Imaging Reporting and Data System, version 2 Grade ≥ 3 on MRI. Age, prostate-specific antigen, prostate volume, positive surgical margin (PSM), lymphovascular invasion, and biochemical recurrence (BCR) were compared between the 2 groups. We also assessed the relationship between visible tumors on MRI and oncologic characteristics.
The visible tumor on the MRI group showed a higher Gleason score ≥4 + 3 [45.8% versus (vs.) 17.7%], high frequency of postoperative PSMs (28.8% vs. 16.7%), and higher BCR rate (17.8% vs. 7.3%) than the no visible tumor on the MRI group. The Kaplan-Meier analysis for BCR-free survival also showed a significant difference ( = 0.006). In multivariate Cox regression analysis, the detection of tumors on MRI was associated with a higher BCR risk [hazard ratio: 3.35; 95% confidence interval (CI): 1.36-8.27; = 0.009]. We found a positive association between visible tumors on MRI and primary Gleason pattern of ≥4 (odds ratio: 4.31; 95% CI: 2.21-8.40; < 0.001).
In localized prostate cancer, BCR was significantly more frequent when the tumor was detected on MRI, and a visible tumor on MRI was associated with the Gleason score. Therefore, attention should be paid to the possibility of high-grade prostate cancer when a tumor is detected on MRI before radical prostatectomy, and active follow-up may be needed postoperatively.
我们研究了肿瘤特征与磁共振成像（MRI）上可见肿瘤之间的关系，并比较了局限性前列腺癌患者MRI检查发现肿瘤与未发现肿瘤的预后情况。
我们回顾性分析了2009年1月至2016年12月期间接受根治性前列腺切除术的214例pT2N0M0前列腺癌患者。所有患者术前均接受了MRI检查。术后将患者分为两组：MRI上未见可见肿瘤组（n = 96，44.9%）和MRI上可见肿瘤组（n = 118，55.1%）。可见肿瘤定义为MRI上前列腺影像报告和数据系统（PI-RADS）第2版分级≥3级。比较两组患者的年龄、前列腺特异性抗原、前列腺体积、手术切缘阳性（PSM）、淋巴管侵犯及生化复发（BCR）情况。我们还评估了MRI上可见肿瘤与肿瘤学特征之间的关系。
与MRI上未见可见肿瘤组相比，MRI上可见肿瘤组的Gleason评分≥4 + 3比例更高（45.8% 对 17.7%）、术后PSM发生率更高（28.8% 对 16.7%）、BCR率更高（17.8% 对 7.3%）。BCR无进展生存的Kaplan-Meier分析也显示出显著差异（P = 0.006）。在多因素Cox回归分析中，MRI检查发现肿瘤与更高的BCR风险相关[风险比：3.35；95%置信区间（CI）：1.36 - 8.27；P = 0.009]。我们发现MRI上可见肿瘤与主要Gleason模式≥4之间存在正相关（比值比：4.31；95% CI：2.21 - 8.40；P < 0.001）。
在局限性前列腺癌中，MRI检查发现肿瘤时BCR明显更常见，且MRI上的可见肿瘤与Gleason评分相关。因此，在根治性前列腺切除术前行MRI检查发现肿瘤时，应注意高级别前列腺癌的可能性，术后可能需要积极随访。
