Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France; Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France; Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France.
Eur Urol Oncol. 2023 Aug;6(4):406-413. doi: 10.1016/j.euo.2022.09.005. Epub 2022 Oct 21.
Local staging of prostate cancer (PCa) still relies on digital rectal examination (DRE), which therefore remains the standard for risk stratification in guideline recommendations, clinical trials, and patient counseling. This issue is increasingly controversial as multiparametric magnetic resonance imaging (mpMRI) has become the most influential diagnostic tool for local staging of PCa over the past two decades.
To compare various models of T category based on DRE or mpMRI to predict early biochemical recurrence (BCR) after radical prostatectomy (RP).
DESIGN, SETTING, AND PARTICIPANTS: A retrospective multicenter cohort study was conducted between 2014 and 2021. A total of 1436 patients were recruited across eight referral centers in France, Italy, Switzerland, and Belgium.
BCR was defined as two prostate-specific antigen values of ≥0.2 ng/ml during follow-up. Harrell's concordance index (C index) was used to compare the discrimination of four models of T staging based on DRE (model 1: cT1 vs cT2 vs cT3) or mpMRI (model 2: organ-confined disease vs extracapsular extension [iECE] vs seminal vesicle invasion [iSVI]; model 3: Prostate Imaging-Reporting and Data System [PI-RADS] ≤3 vs PI-RADS 4 vs PI-RADS 5; and model 4: iT2a [PI-RADS ≤3] vs iT2b [PI-RADS 4] vs iT2c [PI-RADS 5 excluding ECE or SVI] vs iT3a [ECE] vs iT3b [SVI]) to predict BCR.
Overall, 74 (5%), 845 (59%), 482 (34%), and 35 (2%) patients had low-, intermediate-, high-, and very high-risk PCa, respectively, according to the Mazzone risk classification. After median follow-up of 16 mo, 113 patients experienced BCR. Although the new five-group mpMRI-based T classification system (model 4) had the highest prognostic discrimination (C index 0.694) for predicting early BCR on multivariable analysis, there was overlap between the 95% confidence intervals of the models. On sensitivity analysis, the new mpMRI-based T staging still had a higher C index than DRE for predicting BCR when excluding cN1 patients and comparing it with a five-group DRE-based T classification (cT1c vs cT2a vs cT2b vs cT2c vs cT3), but the overlap between the 95% confidence intervals of the models remained. The main limitation is the short follow-up.
We described an alternative mpMRI-based T staging for prediction of early BCR after RP for PCa. Our results need to be validated externally before they can be applied in clinical practice.
At present, digital rectal examination of the prostate is used to stage prostate cancer. We developed an alternative model for staging that uses information from magnetic resonance imaging (MRI) scans to predict cancer outcomes for men undergoing surgical removal of the prostate.
前列腺癌（PCa）的局部分期仍然依赖于直肠指检（DRE），因此它仍然是指南推荐、临床试验和患者咨询中风险分层的标准。随着过去二十年多参数磁共振成像（mpMRI）成为 PCa 局部分期最有影响力的诊断工具，这一问题变得越来越有争议。
比较基于 DRE 或 mpMRI 的各种 T 分期模型，以预测根治性前列腺切除术后（RP）的早期生化复发（BCR）。
设计、地点和参与者：这是一项回顾性多中心队列研究，于 2014 年至 2021 年进行。共招募了来自法国、意大利、瑞士和比利时 8 个转诊中心的 1436 名患者。
BCR 定义为随访期间两次前列腺特异性抗原值≥0.2ng/ml。采用 Harrell 一致性指数（C 指数）比较基于 DRE 的四种 T 分期模型（模型 1：cT1 与 cT2 与 cT3）或 mpMRI（模型 2：器官局限性疾病与包膜外延伸[ECE]与精囊侵犯[SVI]；模型 3：前列腺影像报告和数据系统[PI-RADS]≤3 与 PI-RADS 4 与 PI-RADS 5；模型 4：iT2a [PI-RADS≤3]与 iT2b [PI-RADS 4]与 iT2c [PI-RADS 5 排除 ECE 或 SVI]与 iT3a [ECE]与 iT3b [SVI]）预测 BCR 的能力。
根据 Mazzone 风险分类，总体而言，分别有 74（5%）、845（59%）、482（34%）和 35（2%）名患者为低危、中危、高危和极高危 PCa。在中位随访 16 个月后，113 名患者发生 BCR。尽管新的基于五组 mpMRI 的 T 分类系统（模型 4）在多变量分析中对预测早期 BCR 具有最高的预后判别能力（C 指数 0.694），但各模型的 95%置信区间仍有重叠。在敏感性分析中，当排除 cN1 患者并将新的基于 mpMRI 的 T 分期与基于五组 DRE 的 T 分类（cT1c 与 cT2a 与 cT2b 与 cT2c 与 cT3）进行比较时，新的基于 mpMRI 的 T 分期仍比 DRE 具有更高的 C 指数来预测 BCR，但各模型的 95%置信区间仍有重叠。主要的局限性是随访时间短。
我们描述了一种用于预测 RP 后 PCa 早期 BCR 的替代基于 mpMRI 的 T 分期。在将其应用于临床实践之前，我们需要对其进行外部验证。
目前，前列腺的直肠指检用于分期前列腺癌。我们开发了一种替代模型，该模型使用磁共振成像（MRI）扫描信息来预测接受前列腺切除术的男性的癌症结果。
