Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY.
Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY.
Clin Genitourin Cancer. 2022 Aug;20(4):319-325. doi: 10.1016/j.clgc.2022.04.001. Epub 2022 Apr 14.
INTRODUCTION/BACKGROUND: Magnetic resonance imaging (MRI) misses a proportion of "clinically significant" prostate cancers (csPC) as defined by histopathology criteria. The aim of this study was to analyze whether long-term oncologic outcomes differ between MRI-detectable and MRI-occult csPC.
Retrospective analysis of 1449 patients with pre-prostatectomy MRI and csPC on prostatectomy specimens (ie, Grade group ≥2 or extraprostatic spread) between 2001-2006. T2-weighted MRIs were classified according to the Prostate Imaging Reporting and Data System into MRI-occult (categories 1, 2), MRI-equivocal (category 3), and MRI-detectable (categories 4, 5). Cumulative incidence of biochemical recurrence (BCR), metastatic disease, and cancer-specific mortality, estimated with competing risk models. The median follow-up in survivors was 11.0 years (IQR: 8.9-13.1).
In 188 (13%) cases, csPC was MRI-occult, 435 (30%) MRIs were equivocal, and 826 (57%) csPC were MRI-detectable. The 15-year cumulative incidence [95% CI] of BCR was 8.3% [2.2, 19.5] for MRI-occult cases, 17.4% [11.1, 24.8] for MRI-equivocal cases, and 43.3% [38.7, 47.8] for MRI-detectable cases (P < .001). The cumulative incidences of metastases were 0.61% [0.06, 3.1], 3.5% [1.5, 6.9], and 19.6% [15.4, 24.2] for MRI-occult, MRI-equivocal, and MRI-detectable cases, respectively (P < .001). There were no deaths from prostate cancer observed in patients with MRI-occult csPC, compared to an estimated 1.9% [0.54, 4.9], and 7.1 % [4.5, 10.6] for patients with MRI-equivocal and MRI-detectable cancer, respectively (P < .001).
Oncologic outcomes after prostatectomy for csPC differ between MRI-occult and MRI-detectable lesions. Judging the clinical significance of a negative prostate MRI based on histopathologic surrogates alone might be misleading.
Among 1449 patients with pre-prostatectomy MRI and clinically significant prostate cancer on prostatectomy histopathology, MRI-occult cancers (n = 188, 13%) were less likely to recur biochemically (8% vs. 43%, P < .001), metastasize (0.6% vs. 20%, P < .001), or lead to prostate cancer mortality (0% vs. 7%, P < .001) than MRI-detectable cancers (n = 826, 57%). MRI-occult cancers constitute a prognostically distinct subgroup among higher-grade prostate cancers.
介绍/背景：磁共振成像（MRI）漏诊了一部分组织病理学标准定义的“临床显著”前列腺癌（csPC）。本研究旨在分析 MRI 可检测和 MRI 隐匿性 csPC 的长期肿瘤学结局是否存在差异。
对 2001 年至 2006 年间行前列腺切除术的 1449 例术前 MRI 检查和 csPC 患者（即，Gleason 分级≥2 或外生扩散）进行回顾性分析。根据前列腺成像报告和数据系统（Prostate Imaging Reporting and Data System），T2 加权 MRI 分为 MRI 隐匿性（1、2 类）、MRI 可疑（3 类）和 MRI 可检测（4、5 类）。采用竞争风险模型估计生化复发（BCR）、转移性疾病和癌症特异性死亡率的累积发生率。幸存者的中位随访时间为 11.0 年（IQR：8.9-13.1）。
在 188 例（13%）csPC 中 MRI 隐匿性，435 例（30%）MRI 可疑，826 例（57%）csPC 为 MRI 可检测。MRI 隐匿性病例的 15 年累积 BCR 发生率为 8.3%[2.2，19.5]，MRI 可疑性病例为 17.4%[11.1，24.8]，MRI 可检测性病例为 43.3%[38.7，47.8]（P<0.001）。MRI 隐匿性、MRI 可疑性和 MRI 可检测性病例的转移累积发生率分别为 0.61%[0.06，3.1]、3.5%[1.5，6.9]和 19.6%[15.4，24.2]（P<0.001）。在 MRI 隐匿性 csPC 患者中未观察到前列腺癌死亡，而 MRI 可疑性和 MRI 可检测性癌症患者的估计死亡率分别为 1.9%[0.54，4.9]和 7.1%[4.5，10.6]（P<0.001）。
前列腺切除术治疗 csPC 的肿瘤学结局在 MRI 隐匿性和 MRI 可检测性病变之间存在差异。仅根据组织病理学替代物判断阴性前列腺 MRI 的临床意义可能会产生误导。
在 1449 例接受前列腺切除术的术前 MRI 检查和前列腺切除术后组织病理学证实为临床显著前列腺癌的患者中，MRI 隐匿性癌症（n=188，13%）发生生化复发（8% vs. 43%，P<0.001）、转移（0.6% vs. 20%，P<0.001）或导致前列腺癌死亡（0% vs. 7%，P<0.001）的可能性低于 MRI 可检测性癌症（n=826，57%）。MRI 隐匿性癌症构成了高级别前列腺癌中预后不同的亚组。
