Majchrzak Natalia, Cieśliński Piotr, Głyda Maciej, Karmelita-Katulska Katarzyna
Transplantology, General Surgery and Urology Department, Poznan District Hospital, Juraszow 7-19, 60-479 Poznan, Poland.
Hepatobiliary and General Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Clin Pract. 2021 Oct 9;11(4):763-774. doi: 10.3390/clinpract11040091.
Proper planning of laparoscopic radical prostatectomy (RP) in patients with prostate cancer (PCa) is crucial to achieving good oncological results with the possibility of preserving potency and continence.
The aim of this study was to identify the radiological and clinical parameters that can predict the risk of extraprostatic extension (EPE) for a specific site of the prostate. Predictive models and multiparametric magnetic resonance imaging (mpMRI) data from patients qualified for RP were compared.
The study included 61 patients who underwent laparoscopic RP. mpMRI preceded transrectal systematic and cognitive fusion biopsy. Martini, Memorial Sloan-Kettering Cancer Center (MSKCC), and Partin Tables nomograms were used to assess the risk of EPE. The area under the curve (AUC) was calculated for the models and compared. Univariate and multivariate logistic regression analyses were used to determine the combination of variables that best predicted EPE risk based on final histopathology.
The combination of mpMRI indicating or suspecting EPE (odds ratio (OR) = 7.49 (2.31-24.27), < 0.001) and PSA ≥ 20 ng/mL (OR = 12.06 (1.1-132.15), = 0.04) best predicted the risk of EPE for a specific side of the prostate. For the prediction of ipsilateral EPE risk, the AUC for Martini's nomogram vs. mpMRI was 0.73 ( < 0.001) vs. 0.63 ( = 0.005), respectively ( = 0.131). The assessment of a non-specific site of EPE by MSKCC vs. Partin Tables showed AUC values of 0.71 ( = 0.007) vs. 0.63 ( = 0.074), respectively ( = 0.211).
The combined use of mpMRI, the results of the systematic and targeted biopsy, and prostate-specific antigen baseline can effectively predict ipsilateral EPE (pT3 stage).
对前列腺癌（PCa）患者进行腹腔镜根治性前列腺切除术（RP）的合理规划对于在保留性功能和控尿功能的同时取得良好的肿瘤学效果至关重要。
本研究的目的是确定能够预测前列腺特定部位前列腺外侵犯（EPE）风险的放射学和临床参数。比较了接受RP患者的预测模型和多参数磁共振成像（mpMRI）数据。
该研究纳入了61例行腹腔镜RP的患者。mpMRI在经直肠系统及认知融合活检之前进行。使用马提尼、纪念斯隆凯特琳癌症中心（MSKCC）和帕廷表格列线图来评估EPE风险。计算各模型的曲线下面积（AUC）并进行比较。采用单因素和多因素逻辑回归分析来确定基于最终组织病理学结果能最佳预测EPE风险的变量组合。
mpMRI提示或怀疑存在EPE（比值比（OR）=7.49（2.31 - 24.27），P<0.001）与前列腺特异性抗原（PSA）≥20 ng/mL（OR = 12.06（1.1 - 132.15），P = 0.04）的组合能最佳预测前列腺特定侧的EPE风险。对于预测同侧EPE风险，马提尼列线图的AUC为0.73（P<0.001），而mpMRI的AUC为0.63（P = 0.005）（P = 0.131）。MSKCC与帕廷表格对非特异性EPE部位的评估显示，AUC值分别为0.71（P = 0.007）和0.63（P = 0.074）（P = 0.211）。
联合使用mpMRI、系统及靶向活检结果以及前列腺特异性抗原基线能够有效预测同侧EPE（pT3期）。
