通过前列腺癌风险分层减少前列腺活检和磁共振成像
Reducing prostate biopsies and magnetic resonance imaging with prostate cancer risk stratification.
作者信息
Davik Petter, Remmers Sebastiaan, Elschot Mattijs, Roobol Monique J, Bathen Tone Frost, Bertilsson Helena
机构信息
Department of Clinical and Molecular Medicine NTNU - Norwegian University of Science and Technology Trondheim Norway.
Department of Urology St. Olav's Hospital Trondheim Norway.
出版信息
BJUI Compass. 2022 Apr 22;3(5):344-353. doi: 10.1002/bco2.146. eCollection 2022 Sep.
OBJECTIVES
To recalibrate and validate the European Randomized Study of Screening for Prostate Cancer risk calculators (ERSPC RCs) 3/4 and the magnetic resonance imaging (MRI)-ERSPC-RCs to a contemporary Norwegian setting to reduce upfront prostate multiparametric MRI (mpMRI) and prostate biopsies.
PATIENTS AND METHODS
We retrospectively identified and entered all men who underwent prostate mpMRI and subsequent prostate biopsy between January 2016 and March 2017 in a Norwegian centre into a database. mpMRI was reported using PI-RADS v2.0 and clinically significant prostate cancer (csPCa) defined as Gleason ≥ 3 + 4. Probabilities of csPCa and any prostate cancer (PCa) on biopsy were calculated by the ERSPC RCs 3/4 and the MRI-ERSPC-RC and compared with biopsy results. RCs were then recalibrated to account for differences in prevalence between the development and current cohorts (if indicated), and calibration, discrimination and clinical usefulness assessed.
RESULTS
Three hundred and three patients were included. The MRI-ERSPC-RCs were perfectly calibrated to our cohort, although the ERSPC RCs 3/4 needed recalibration. Area under the receiver operating curve (AUC) for the ERSPC RCs 3/4 was 0.82 for the discrimination of csPCa and 0.77 for any PCa. The AUC for the MRI-ERSPC-RCs was 0.89 for csPCa and 0.85 for any PCa. Decision curve analysis showed clear net benefit for both the ERSPC RCs 3/4 (>2% risk of csPCa threshold to biopsy) and for the MRI-ERSPC-RCs (>1% risk of csPCa threshold), with a greater net benefit for the MRI-RCs. Using a >10% risk of csPCa or 20% risk of any PCa threshold for the ERSPC RCs 3/4, 15.5% of mpMRIs could be omitted, missing 0.8% of csPCa. Using the MRI-ERSPC-RCs, 23.4% of biopsies could be omitted with the same threshold, missing 0.8% of csPCa.
CONCLUSION
The ERSPC RCs 3/4 and MRI-ERSPC-RCs can considerably reduce both upfront mpMRI and prostate biopsies with little risk of missing csPCa.
目的
将欧洲前列腺癌筛查随机研究风险计算器（ERSPC RCs）3/4以及磁共振成像（MRI）-ERSPC-RCs重新校准并验证至当代挪威的情况，以减少前期前列腺多参数磁共振成像（mpMRI）和前列腺活检。
患者与方法
我们回顾性地识别并录入了2016年1月至2017年3月在挪威一个中心接受前列腺mpMRI及后续前列腺活检的所有男性，并将其纳入数据库。mpMRI采用PI-RADS v2.0报告，临床显著性前列腺癌（csPCa）定义为Gleason评分≥3 + 4。ERSPC RCs 3/4和MRI-ERSPC-RC计算活检时csPCa和任何前列腺癌（PCa）的概率，并与活检结果进行比较。然后对风险计算器进行重新校准，以考虑开发队列和当前队列之间患病率的差异（如需要），并评估校准、区分能力和临床实用性。
结果
纳入303例患者。MRI-ERSPC-RCs与我们的队列完美校准，尽管ERSPC RCs 3/4需要重新校准。ERSPC RCs 3/4用于区分csPCa的受试者工作特征曲线下面积（AUC）为0.82，用于区分任何PCa的AUC为0.77。MRI-ERSPC-RCs用于csPCa的AUC为0.89，用于任何PCa的AUC为0.85。决策曲线分析显示，ERSPC RCs 3/4（csPCa活检阈值风险>2%）和MRI-ERSPC-RCs（csPCa活检阈值风险>1%）均有明显的净效益，MRI风险计算器的净效益更大。对于ERSPC RCs 3/4，使用csPCa风险>10%或任何PCa风险20%的阈值，可省略15.5%的mpMRI，漏诊0.8%的csPCa。使用MRI-ERSPC-RCs，在相同阈值下可省略23.4%的活检，漏诊0.8%的csPCa。
结论
ERSPC RCs 3/4和MRI-ERSPC-RCs可显著减少前期mpMRI和前列腺活检，且漏诊csPCa的风险很小。
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