[前列腺癌根治术前预测国际泌尿病理学会（ISUP）病理分级≥2的模型的建立与评估]

[Establishment and evaluation of a model for predicting ISUP pathological grade≥2 before radical prostatectomy].

作者信息

Wang Y F, Zhang Y Y, Tan S X, Pan P, Wei C G, Shen J K

机构信息

Department of Imaging, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2021 Dec 7;101(45):3754-3759. doi: 10.3760/cma.j.cn112137-20210824-01915.

DOI:10.3760/cma.j.cn112137-20210824-01915

PMID:34856705

Abstract

Based on the 2014 version of the International Association of Urological Pathology (ISUP) pathological classification standards, a prediction model that can predict the pathological classification of ISUP ≥2 in patients with prostate cancer (PCa) before radical prostatectomy (RP) was established and evaluated. The clinical data of 171 patients who had undergone RP from January 2017 to September 2020 in the Second Affiliated Hospital of Soochow University and obtained postoperative pathological results of all specimens were retrospectively collected. The patients were 46-83 (70±7) years old. For patients with RP ISUP pathologic stage as the gold standard, according to the pathological grading is level 2 or higher is divided into two groups(42 patients with ISUP grade=1 and 129 patients with ISUP grade ≥2). the predictors of ISUP pathology grade ≥2 after RP were screened by logistics regression analysis, predictive models were established and ROC curves were used to evaluate the efficacy of each model in diagnosing RP with pathological grade ≥2, and comparisons were conducted by DeLong test. Compared with patients with ISUP grade=1, patients with ISUP grade≥2 had higher prostate specific antigen (PSA) and prostate specific antigen density (PSAD) (14.21(8.57, 24.98)ng/ml vs 7.98(5.41, 12.54)ng/ml, 0.33(0.20, 0.74)μg.L.ml vs 0.16(0.12, 0.24)μg.L.ml), lower prostate volume (PV) (48.62(34.17,73.99)ml vs 38.94(28.15,54.84)ml)(all <0.05). Multi-parameter magnetic resonance imaging (mp-MRI) prostate imaging and reporting system (PI-RADS) score, the positive ratio of puncture needles and the pathological grade of puncture ISUP were also significantly different between the two groups (all <0.05). The combined mp-MRI PI-RADS score (=3.337, 95% 1.990-5.593, <0.001) and puncture ISUP pathological grading (=4.041, 95% 1.960-8.334, <0.001) had the highest diagnostic efficacy for pathological grading ≥2 after RP (AUC=0.916, <0.05). The combined mp-MRI PI-RADS score and puncture ISUP pathological grading had the highest diagnostic efficacy for pathological grading ≥2 after RP.

摘要

基于2014版国际泌尿病理学会（ISUP）病理分类标准，建立并评估了一种能在前列腺癌（PCa）患者根治性前列腺切除术（RP）前预测ISUP≥2级病理分类的预测模型。回顾性收集了2017年1月至2020年9月在苏州大学附属第二医院接受RP且获得所有标本术后病理结果的171例患者的临床资料。患者年龄为46 - 83岁（70±7岁）。以RP的ISUP病理分期为金标准，根据病理分级为2级或更高分为两组（42例ISUP 1级患者和129例ISUP≥2级患者）。通过逻辑回归分析筛选RP后ISUP病理分级≥2的预测因素，建立预测模型，并用ROC曲线评估各模型诊断RP病理分级≥2的效能，通过DeLong检验进行比较。与ISUP 1级患者相比，ISUP≥2级患者的前列腺特异性抗原（PSA）和前列腺特异性抗原密度（PSAD）更高（14.21（8.57，24.98）ng/ml对7.98（5.41，12.54）ng/ml，0.33（0.20，0.74）μg·L·ml对0.16（0.12，0.24）μg·L·ml），前列腺体积（PV）更低（48.62（34.17，73.99）ml对38.94（28.15，54.84）ml）（均P<0.05）。两组间多参数磁共振成像（mp - MRI）前列腺影像报告和数据系统（PI - RADS）评分、穿刺针阳性率及穿刺ISUP病理分级也有显著差异（均P<0.05）。联合mp - MRI PI - RADS评分（=3.337，95% 1.990 - 5.593，P<0.001）和穿刺ISUP病理分级（=4.041，95% 1.960 - 8.334，P<0.001）对RP后病理分级≥2的诊断效能最高（AUC = 0.916，P<0.05）。联合mp - MRI PI - RADS评分和穿刺ISUP病理分级对RP后病理分级≥2的诊断效能最高。