影像技术及TMPRSS2:ERG突变在临床显著性前列腺癌诊断中作用的前瞻性评估
Prospective evaluation of the role of imaging techniques and TMPRSS2:ERG mutation for the diagnosis of clinically significant prostate cancer.
作者信息
Lazzeri Massimo, Fasulo Vittorio, Lughezzani Giovanni, Benetti Alessio, Soldà Giulia, Asselta Rosanna, De Simone Ilaria, Paciotti Marco, Avolio Pier Paolo, Contieri Roberto, Saitta Cesare, Saita Alberto, Hurle Rodolfo, Guazzoni Giorgio, Buffi Nicolò Maria, Casale Paolo
机构信息
Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
出版信息
Front Oncol. 2022 Sep 6;12:968384. doi: 10.3389/fonc.2022.968384. eCollection 2022.
OBJECTIVES
To test the hypothesis of a relationship between a specific genetic lesion (T2:ERG) and imaging scores, such as PI-RADS and PRI-MUS, and to test the effectiveness of these parameters for the diagnosis of prostate cancer (PCa) and clinically significant PCa (csPCa).
MATERIALS AND METHODS
This is a prospective study of men with suspected PCa enrolled between 2016 and 2019 at a high-volume tertiary hospital. Patients underwent systematic US-guided biopsy, plus targeted biopsy if they were presenting with >=1 suspicious lesion (PI-RADS>2) at mpMRI or PR-IMUS >2 at micro-ultrasound assessment. For each patient, one core from the highest PI-RADS or PRI-MUS lesion was collected for T2:ERG analysis. Multivariable logistic regression models (LRMs) were fitted for csPCa with a clinical model (age, total PSA, previous biopsy, family history for PCa), a clinical plus PI-RADS, clinical plus T2:ERG, clinical plus PI-RADS plus T2:ERG, and T2:ERG plus PI-RADS alone.
RESULTS
The cohort consists of 158 patients: 83.5% and 66.2% had respectively a diagnosis of PCa and csPCa after biopsy. A T2:ERG fusion was found in 37 men and 97.3% of these patients harbored PCa, while 81.1% were diagnosed with csPCa. SE of T2:ERG assay for csPCa was 28.8%, SP 87.0%, NPV 38.8%, and PPV 81.1%. Of 105 patients who performed mpMRI 93.% had PIRADS ≥3. SE of mpMRI for csPCa was 98.5%, SP was 12.8%, NPV was 83.3%, and PPV was 65.7%. Among 67 patients who were subjected to micro-US, 90% had a PRI-MUS ≥3. SE of micro-US for csPCa was 89.1%, SP was 9.52%, NPV was 28.6%, and PPV was 68.3%. At univariable LRM T2:ERG was confirmed as independent of mpMRI and micro-US result (OR 1.49, p=0.133 and OR 1.82, p=0.592, respectively). At multivariable LRM the clinical model alone had an AUC for csPCa of 0.74 while the clinical model including PI-RADS and T2:ERG achieved an AUC of 0.83.
CONCLUSIONS
T2:ERG translocation and imaging results are independent of each other, but both are related csPCa. To evaluate the best diagnostic work-up for PCa and csPCa detection, all available tools (T2:ERG detection and imaging techniques) should be employed together as they appear to have a complementary role.
目的
检验特定基因病变（T2:ERG）与影像评分（如PI-RADS和PRI-MUS）之间关系的假设，并检验这些参数对前列腺癌（PCa）和临床显著性前列腺癌（csPCa）诊断的有效性。
材料与方法
这是一项对2016年至2019年期间在一家大型三级医院登记的疑似PCa男性患者的前瞻性研究。患者接受系统性超声引导下活检，若在多参数磁共振成像（mpMRI）上出现≥1个可疑病变（PI-RADS>2）或在微超声评估中PR-IMUS>2，则进行靶向活检。对于每位患者，从最高PI-RADS或PRI-MUS病变处采集一个样本进行T2:ERG分析。采用多变量逻辑回归模型（LRMs），以临床模型（年龄、总前列腺特异性抗原、既往活检、PCa家族史）、临床加PI-RADS、临床加T2:ERG、临床加PI-RADS加T2:ERG以及单独的T2:ERG加PI-RADS来诊断csPCa。
结果
该队列由158名患者组成：活检后分别有83.5%和66.2%的患者被诊断为PCa和csPCa。在37名男性中发现了T2:ERG融合，这些患者中有97.3%患有PCa，而81.1%被诊断为csPCa。T2:ERG检测对csPCa的敏感性为28.8%，特异性为87.0%，阴性预测值为38.8%，阳性预测值为81.1%。在105名进行mpMRI的患者中，93%的患者PI-RADS≥3。mpMRI对csPCa的敏感性为98.5%，特异性为12.8%，阴性预测值为83.3%，阳性预测值为65.7%。在67名接受微超声检查的患者中，90%的患者PRI-MUS≥3。微超声对csPCa的敏感性为89.1%，特异性为9.52%，阴性预测值为28.6%，阳性预测值为68.3%。在单变量LRM中，T2:ERG被确认为独立于mpMRI和微超声结果（OR分别为1.49，p = 0.133和OR为1.82，p = 0.592）。在多变量LRM中，仅临床模型对csPCa的曲线下面积（AUC）为0.74，而包括PI-RADS和T2:ERG的临床模型AUC为0.83。
结论
T2:ERG易位与影像结果相互独立，但两者均与csPCa相关。为评估PCa和csPCa检测的最佳诊断方法，所有可用工具（T2:ERG检测和影像技术）应一起使用，因为它们似乎具有互补作用。
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