Alqahtani Saeed, Zhang Xinyu, Wei Cheng, Zhang Yilong, Szewczyk-Bieda Magdalena, Wilson Jennifer, Huang Zhihong, Nabi Ghulam
Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK.
School of Science and Engineering, University of Dundee, Dundee DD1 9SY, UK.
Cancers (Basel). 2021 Dec 21;14(1):1. doi: 10.3390/cancers14010001.
The study was aimed to develop a predictive model to identify patients who may benefit from performing systematic random biopsies (SB) in addition to targeted biopsies (TB) in men suspected of having prostate cancer. A total of 198 patients with positive pre-biopsy MRI findings and who had undergone both TB and SB were prospectively recruited into this study. The primary outcome was detection rates of clinically significant prostate cancer (csPCa) in SB and TB approaches. The secondary outcome was net clinical benefits of SB in addition to TB. A logistic regression model and nomogram construction were used to perform a multivariate analysis. The detection rate of csPCa using SB was 51.0% (101/198) compared to a rate of 56.1% (111/198) for TB, using a patient-based biopsy approach. The detection rate of csPCa was higher using a combined biopsy (64.6%; 128/198) in comparison to TB (56.1%; 111/198) alone. This was statistically significant ( < 0.001). Age, PSA density and PIRADS score significantly predicted the detection of csPCa by SB in addition to TB. A nomogram based on the model showed good discriminative ability (C-index; 78%). The decision analysis curve confirmed a higher net clinical benefit at an acceptable threshold.
本研究旨在开发一种预测模型，以识别除靶向活检（TB）外，可能从系统性随机活检（SB）中获益的疑似前列腺癌男性患者。共有198例活检前MRI检查结果为阳性且已接受TB和SB的患者被前瞻性纳入本研究。主要结局是SB和TB方法中临床显著前列腺癌（csPCa）的检出率。次要结局是除TB外SB的净临床获益。采用逻辑回归模型和列线图构建进行多变量分析。采用基于患者的活检方法，SB检测csPCa的比率为51.0%（101/198），而TB为56.1%（111/198）。与单独使用TB（56.1%；111/198）相比，联合活检（64.6%；128/198）检测csPCa的比率更高。这具有统计学意义（<0.001）。年龄、PSA密度和PIRADS评分除了能显著预测TB外，还能显著预测SB检测csPCa的情况。基于该模型的列线图显示出良好的判别能力（C指数；78%）。决策分析曲线证实，在可接受的阈值下具有更高的净临床获益。
