Morote Juan, Borque-Fernando Angel, Triquell Marina, Celma Anna, Regis Lucas, Mast Richard, de Torres Inés M, Semidey María E, Santamaría Anna, Planas Jacques, Esteban Luis M, Trilla Enrique
Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain.
Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
Cancers (Basel). 2022 Apr 5;14(7):1828. doi: 10.3390/cancers14071828.
We sought to find further evidence showing the increase in PCa aggressiveness as PI-RADS score increases from four surrogates of PCa aggressiveness: i. prostate biopsy GG (≤3 vs. >3), ii. type of pathology in surgical specimens (favourable vs. unfavourable), iii. clinical stage (localised vs. advanced), and risk of recurrence of localised PCa after primary treatment (low-intermediate vs. high). A group of 692 PCa patients were diagnosed after 3-T multiparametric MRI (mpMRI) and guided and/or systematic biopsies, showing csPCa (GG ≥ 2) in 547 patients (79%) and insignificant PCa (iPCa) in 145 (21%). The csPCa rate increased from 32.4% in PI-RADS < 3 to 95.5% in PI-RADS 5 (p < 0.001). GG ≥ 3 was observed in 7.6% of PCa with PI-RADS < 3 and 32.6% in those with PI-RADS > 3 (p < 0.001). Unfavourable pathology was observed in 38.9% of PCa with PI-RAD < 3 and 68.3% in those with PI-RADS > 3 (p = 0.030). Advanced disease was not observed in PCa with PI-RADS ≤ 3, while it existed in 12.7% of those with PI-RADS > 3 (p < 0.001). High-risk recurrence localised PCa was observed in 9.5% of PCa with PI-RADS < 3 and 35% in those with PI-RADS > 3 (p = 0.001). The PI-RADS score was an independent predictor of all surrogates of PCa aggressiveness as PSA density. We confirmed that mpMRI grades PCa aggressiveness.
我们试图从前列腺癌侵袭性的四个替代指标中找到进一步证据，以表明随着PI-RADS评分增加，前列腺癌侵袭性增强：i. 前列腺活检Gleason分级（≤3级与>3级），ii. 手术标本中的病理类型（有利与不利），iii. 临床分期（局限性与晚期），以及局限性前列腺癌初次治疗后的复发风险（低-中级与高级）。一组692例前列腺癌患者经3-T多参数磁共振成像（mpMRI）及引导和/或系统活检确诊，其中547例（79%）为临床显著前列腺癌（csPCa，Gleason分级≥2级），145例（21%）为非显著性前列腺癌（iPCa）。csPCa发生率从PI-RADS<3时的32.4%增至PI-RADS 5时的95.5%（p<0.001）。PI-RADS<3的前列腺癌中7.6%观察到Gleason分级≥3级，PI-RADS>3的前列腺癌中这一比例为32.6%（p<0.001）。PI-RAD<3的前列腺癌中38.9%观察到不利病理类型，PI-RADS>3的前列腺癌中这一比例为68.3%（p=0.030）。PI-RADS≤3的前列腺癌未观察到晚期疾病，而PI-RADS>3的前列腺癌中有12.7%存在晚期疾病（p<0.001）。PI-RADS<3的前列腺癌中9.5%观察到高风险复发性局限性前列腺癌，PI-RADS>3的前列腺癌中这一比例为35%（p=0.001）。PI-RADS评分是前列腺癌侵袭性所有替代指标（如PSA密度）的独立预测因子。我们证实mpMRI可对前列腺癌侵袭性进行分级。
