用于预测临床显著前列腺癌的鹿特丹和巴塞罗那磁共振成像风险计算器的比较
Comparison of Rotterdam and Barcelona Magnetic Resonance Imaging Risk Calculators for Predicting Clinically Significant Prostate Cancer.
作者信息
Morote Juan, Borque-Fernando Ángel, Triquell Marina, Campistol Miriam, Servian Pol, Abascal José M, Planas Jacques, Méndez Olga, Esteban Luis M, Trilla Enrique
机构信息
Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain.
Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain.
出版信息
Eur Urol Open Sci. 2023 May 22;53:46-54. doi: 10.1016/j.euros.2023.03.013. eCollection 2023 Jul.
BACKGROUND
Magnetic resonance imaging (MRI)-based risk calculators (MRI-RCs) individualise the likelihood of clinically significant prostate cancer (csPCa) and improve candidate selection for prostate biopsy beyond the Prostate Imaging Reporting and Data System (PI-RADS).
OBJECTIVE
To compare the Barcelona (BCN) and Rotterdam (ROT) MRI-RCs in an entire population and according to the PI-RADS categories.
DESIGN SETTING AND PARTICIPANTS
A prospective comparison of BCN- and ROT-RC in 946 men with suspected prostate cancer in whom systematic biopsy was performed, as well as target biopsies of PI-RADS ≥3 lesions.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Saved biopsies and undetected csPCa (grade group ≥2) were determined.
RESULTS AND LIMITATIONS
The csPCa detection was 40.8%. The median risks of csPCa from BCN- and ROT-RC were, respectively, 67.1% and 25% in men with csPCa, whereas 10.5% and 3% in those without csPCa ( < 0.001). The areas under the curve were 0.856 and 0.844, respectively ( = 0.116). BCN-RC showed a higher net benefit and clinical utility over ROT-RC. Using appropriate thresholds, respectively, 75% and 80% of biopsies were needed to identify 50% of csPCa detected in men with PI-RADS <3, whereas 35% and 21% of biopsies were saved, missing 10% of csPCa detected in men with PI-RADS 3. BCN-RC saved 15% of biopsies, missing 2% of csPCa in men with PI-RADS 4, whereas ROT-RC saved 10%, missing 6%. No RC saved biopsies without missing csPCa in men with PI-RADS 5.
CONCLUSIONS
ROT-RC provided a lower and narrower range of csPCa probabilities than BCN-RC. BCN-RC showed a net benefit over ROT-RC in the entire population. However, BCN-RC was useful in men with PI-RADS 3 and 4, whereas ROT-RC was useful only in those with PI-RADS 3. No RC seemed to be helpful in men with negative MRI and PI-RADS 5.
PATIENT SUMMARY
Barcelona risk calculator was more helpful than Rotterdam risk calculator to select candidates for prostate biopsy.
背景
基于磁共振成像（MRI）的风险计算器（MRI-RC）可个体化评估临床显著性前列腺癌（csPCa）的发生可能性，并在前列腺影像报告和数据系统（PI-RADS）之外改进前列腺活检的候选者选择。
目的
在整个人群中以及根据PI-RADS类别比较巴塞罗那（BCN）和鹿特丹（ROT）的MRI-RC。
设计、场所和参与者：对946例疑似前列腺癌且进行了系统活检以及对PI-RADS≥3病变进行靶向活检的男性患者中的BCN-RC和ROT-RC进行前瞻性比较。
结果测量和统计分析
确定活检的减少情况以及未检测到的csPCa（分级组≥2）。
结果与局限性
csPCa的检出率为40.8%。在患有csPCa的男性中，BCN-RC和ROT-RC预测csPCa的中位风险分别为67.1%和25%，而在未患csPCa的男性中分别为10.5%和3%（P<0.001）。曲线下面积分别为0.856和0.844（P=0.116）。BCN-RC相对于ROT-RC显示出更高的净效益和临床实用性。使用适当的阈值，对于PI-RADS<3的男性，分别需要75%和80%的活检来识别50%检测到的csPCa，而对于PI-RADS 3的男性，分别减少了35%和21%的活检，但遗漏了10%检测到的csPCa。对于PI-RADS 4的男性，BCN-RC减少了15%的活检，遗漏了2%的csPCa，而ROT-RC减少了1%，遗漏了6%。对于PI-RADS 5的男性，没有一种风险计算器能在不遗漏csPCa的情况下减少活检。
结论
ROT-RC提供的csPCa概率范围比BCN-RC更低且更窄。在整个人群中，BCN-RC相对于ROT-RC显示出净效益。然而，BCN-RC对PI-RADS 3和4的男性有用，而ROT-RC仅对PI-RADS 3的男性有用。对于MRI阴性且PI-RADS 5的男性，似乎没有一种风险计算器有帮助。
患者总结
巴塞罗那风险计算器在选择前列腺活检候选者方面比鹿特丹风险计算器更有帮助。
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