Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Urology, Loyola University Medical Center, Maywood, IL.
Urol Oncol. 2023 Feb;41(2):104.e19-104.e27. doi: 10.1016/j.urolonc.2022.10.012. Epub 2022 Nov 10.
Magnetic resonance imaging (MRI) prior to biopsy has improved detection of clinically significant prostate cancer (CaP), but its impact on surgical outcomes is less well established. We compared MRI vs. non-MRI diagnostic pathways among patients receiving radical prostatectomy (RP) for impact on surgical outcomes.
Men diagnosed with CaP and receiving RP at Loyola University Medical Center (2014-2021) were categorized into MRI or non-MRI diagnostic pathways based on receipt of MRI before prostate biopsy. Primary outcomes of interest included positive surgical margin (PSM) rates, the performance of bilateral nerve-sparing, and biochemical recurrence (BCR). Multivariable logistic regression models, Kaplan-Meier curves, and Cox proportional hazards regression were employed.
Of 609 patients, 281 (46.1%) were in the MRI and 328 (53.9%) in the non-MRI groups. MRI patients had similar PSA, biopsy grade group (GG) distribution, RP GG, pT stage, and RP CaP volume compared to non-MRI patients. PSM rates were not statistically different for the MRI vs. non-MRI groups (22.8% vs. 26.8%, P = 0.25). Bilateral nerve-sparing rates were higher for the MRI vs. non-MRI groups (OR 1.95 (95%CI 1.32-2.88), P = 0.001). The MRI group demonstrated improved BCR (HR 0.64 (95%CI 0.41-0.99), P = 0.04) after adjustment for age, PSA, RP GG, pT, pN, and PSM status. On meta-analysis, a 5.2% PSM reduction was observed but high heterogeneity for use of nerve-sparing.
An MRI-based diagnostic approach selected patients for RP with a small reduction in PSM rates, greater utilization of bilateral nerve-sparing, and improved cancer control by BCR compared to a non-MRI approach even after adjustment for known prognostic factors.
磁共振成像（MRI）在活检前提高了临床显著前列腺癌（CaP）的检出率，但对手术结果的影响尚未得到充分证实。我们比较了接受根治性前列腺切除术（RP）的患者中 MRI 与非 MRI 诊断途径对手术结果的影响。
根据前列腺活检前是否接受 MRI，将 2014 年至 2021 年在洛约拉大学医学中心诊断为 CaP 并接受 RP 的男性分为 MRI 或非 MRI 诊断途径。主要观察指标包括阳性切缘（PSM）率、双侧神经保留的表现以及生化复发（BCR）。采用多变量逻辑回归模型、Kaplan-Meier 曲线和 Cox 比例风险回归。
在 609 名患者中，281 名（46.1%）患者入组 MRI 组，328 名（53.9%）患者入组非 MRI 组。MRI 组患者的 PSA、活检分级分组（GG）分布、RP GG、pT 分期和 RP CaP 体积与非 MRI 组患者相似。MRI 组与非 MRI 组的 PSM 率无统计学差异（22.8% vs. 26.8%，P=0.25）。MRI 组双侧神经保留率高于非 MRI 组（OR 1.95（95%CI 1.32-2.88），P=0.001）。在调整年龄、PSA、RP GG、pT、pN 和 PSM 状态后，MRI 组的 BCR 改善（HR 0.64（95%CI 0.41-0.99），P=0.04）。荟萃分析显示，PSM 减少 5.2%，但神经保留的使用存在高度异质性。
与非 MRI 方法相比，基于 MRI 的诊断方法选择接受 RP 的患者，其 PSM 率略有降低，双侧神经保留的利用率更高，BCR 后癌症控制效果更好，尽管调整了已知的预后因素。
