Triquell Marina, Regis Lucas, Winkler Mathias, Valdés Nicolás, Cuadras Mercè, Celma Ana, Planas Jacques, Morote Juan, Trilla Enrique
Department of Urology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.
Department of Surgery, Univesitat Autònoma de Barcelona, 08193 Barcelona, Spain.
Cancers (Basel). 2022 Aug 17;14(16):3966. doi: 10.3390/cancers14163966.
The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016-1.100, = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417-0.770, = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744-25.006, = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025-1.612, = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique.
在多参数磁共振成像（mpMRI）上正确识别前列腺癌（PCa）的包膜外扩展（ECE），对于外科医生规划根治性前列腺切除术中的保留神经方法至关重要。保留神经策略能在保留勃起功能和尿失禁方面带来更好的结果，尽管这可能会因肿瘤学结果较差而受到影响。本研究的目的是评估术前mpMRI预测最终前列腺标本（PS）中ECE的能力，并将识别ECE的其他可能术前预测因素作为次要终点。我们调查了两家大型医院的数据库，以确定那些在活检前进行了mpMRI检查并随后接受了根治性前列腺切除术（RP）的男性患者。计算了mpMRI预测ECE的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。进行单因素分析以发现影像分期与病理分期之间的关联。进行多因素逻辑回归分析以研究其他术前预测因素。总共选择了1147例患者，在这1147例患者中，有203例（17.7%）根据mpMRI被分类为ECE。病理学家在1147个PS中有279例（24.3%）报告有ECE。PPV为0.58，NPV为0.72，敏感性为0.32，特异性为0.88。多因素分析发现，前列腺特异性抗原（PSA）（比值比[OR]1.057，95%置信区间[C.I.]，1.016 - 1.100）、直肠指检（OR 0.567，95% C.I.，0.417 - 0.770）、阳性活检芯比例（OR 9.687，95% C.I.，3.744 - 25.006）以及前列腺活检的分级（OR 1.394，95% C.I.，1.025 - 1.612）是ECE的独立因素。mpMRI有很强的排除ECE的能力，尽管低敏感性仍然是该技术的一个重要局限性。
