Chang Kevin, Greenberg Scott A, Cowan Janet E, Parker Robert, Shee Kevin, Washington Samuel L, Nguyen Hao G, Shinohara Katsuto, Carroll Peter R, Cooperberg Matthew R
Department of Urology, UCSF-Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.
Department of Epidemiology and Biostatistics, UCSF-Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.
J Urol. 2023 Aug;210(2):281-289. doi: 10.1097/JU.0000000000003486. Epub 2023 Apr 26.
Although official T-staging criteria for prostate cancer are based on digital rectal examination findings, providers increasingly rely on transrectal US and MRI to define pragmatic clinical stage to guide management. We assessed the impact of incorporating imaging findings into T-staging on performance of a well-validated prognostic instrument.
Patients who underwent radical prostatectomy for prostate cancer diagnosed between 2000 and 2019 with stage ≤cT3a on both digital rectal examination and imaging (transrectal US/MRI) were included. The University of California, San Francisco CAPRA (Cancer of the Prostate Risk Assessment) score was computed 2 ways: (1) incorporating digital rectal examination-based T stage and (2) incorporating imaging-based T stage. We assessed for risk changes across the 2 methods and associations of CAPRA (by both methods) with biochemical recurrence, using unadjusted and adjusted Cox proportional hazards models. Model discrimination and net benefit were assessed with time-dependent area under the curve and decision curve analysis, respectively.
Of 2,222 men included, 377 (17%) increased in CAPRA score with imaging-based staging ( < .01). Digital rectal examination-based (HR 1.54; 95% CI 1.48-1.61) and imaging-based (HR 1.52; 95% CI 1.46-1.58) CAPRA scores were comparably accurate for predicting recurrence with similar discrimination and decision curve analyses. On multivariable Cox regression, positive digital rectal examination at diagnosis (HR 1.29; 95% CI 1.09-1.53) and imaging-based clinical T3/4 disease (HR 1.72; 95% CI 1.43-2.07) were independently associated with biochemical recurrence.
The CAPRA score remains accurate whether determined using imaging-based staging or digital rectal examination-based staging, with relatively minor discrepancies and similar associations with biochemical recurrence. Staging information from either modality can be used in the CAPRA score calculation and still reliably predict risk of biochemical recurrence.
尽管前列腺癌的官方T分期标准基于直肠指检结果，但医疗服务提供者越来越依赖经直肠超声和磁共振成像来确定实用的临床分期，以指导治疗。我们评估了将影像学检查结果纳入T分期对一种经过充分验证的预后工具性能的影响。
纳入2000年至2019年间因前列腺癌接受根治性前列腺切除术、直肠指检和影像学检查（经直肠超声/磁共振成像）分期均≤cT3a的患者。加利福尼亚大学旧金山分校的CAPRA（前列腺癌风险评估）评分通过两种方式计算：（1）纳入基于直肠指检的T分期；（2）纳入基于影像学的T分期。我们使用未调整和调整后的Cox比例风险模型，评估两种方法之间的风险变化以及CAPRA评分（两种方法）与生化复发的关联。分别使用时间依赖性曲线下面积和决策曲线分析评估模型的辨别力和净效益。
在纳入的2222名男性中，377名（17%）基于影像学分期的CAPRA评分升高（P <.01）。基于直肠指检的CAPRA评分（HR 1.54；95% CI 1.48 - 1.61）和基于影像学的CAPRA评分（HR 1.52；95% CI 1.46 - 1.58）在预测复发方面具有相似的辨别力和决策曲线分析，准确性相当。在多变量Cox回归分析中，诊断时直肠指检阳性（HR 1.29；95% CI 1.09 - 1.53）和基于影像学的临床T3/4期疾病（HR 1.72；95% CI 1.43 - 2.07）与生化复发独立相关。
无论使用基于影像学的分期还是基于直肠指检的分期来确定，CAPRA评分仍然准确，差异相对较小，且与生化复发的关联相似。来自任何一种检查方式的分期信息都可用于计算CAPRA评分，并且仍然能够可靠地预测生化复发风险。
