Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China.
Front Endocrinol (Lausanne). 2023 Oct 4;14:1228892. doi: 10.3389/fendo.2023.1228892. eCollection 2023.
Positive surgical margin (PSM) or apical positive surgical margin (APSM) is an established predictive factor of biochemical recurrence or disease progression in prostate cancer (PCa) patients after radical prostatectomy. Since there are limited usable magnetic resonance imaging (MRI)-based models, we sought to explore the role of three-dimensional (3D) visualization for preoperative MRI in the prediction of PSM or APSM.
From December 2016 to April 2022, 149 consecutive PCa patients who underwent radical prostatectomy were retrospectively selected from the Second Affiliated Hospital of Dalian Medical University. According to the presence of PSM or APSM, patients were divided into a PSM group (n=41) and a without PSM group (n=108) and into an APSM group (n=33) and a without APSM group (n=116). Twenty-one parameters, including prostate apical shape, PCa distance to the membranous urethra, and pubic angle, were measured on 3D visualization of MRI. The development of the nomogram models was built by the findings of multivariate logistic regression analysis for significant factors.
To predict the probability of PSM, a longer PCa distance to the membranous urethra (OR=0.136, p=0.019) and the distance from the anterior peritoneum to the anterior border of the coccyx (work space AP, OR=0.240, p=0.030) were independent protective factors, while a type 3 prostate apical shape (OR=8.262, p=0.025) and larger pubic angle 2 (OR=5.303, p=0.029) were identified as independent risk factors. The nomogram model presented an area under the curve (AUC) of the receiver operating characteristic curve (ROC) of PSM of 0.777. In evaluating the incidence of APSM, we found that the distance to the membranous urethra (OR=0.135, p=0.014) was associated with a low risk of APSM, while larger pubic angle 1 (OR=4.666, p=0.043) was connected to a higher risk of APSM. The nomogram model showed that the AUC of APSM was 0.755.
As 3D visualization for preoperative MRI showed good performance in predicting PSM or APSM, the tool might be potentially valuable, which also needs to be validated by multicenter, large-scale, prospective studies.
在接受根治性前列腺切除术的前列腺癌 (PCa) 患者中，阳性切缘 (PSM) 或顶端阳性切缘 (APSM) 是生化复发或疾病进展的既定预测因素。由于基于磁共振成像 (MRI) 的可用模型有限，我们试图探索三维 (3D) 可视化在预测 PSM 或 APSM 中的作用。
回顾性分析 2016 年 12 月至 2022 年 4 月期间在大连医科大学附属第二医院接受根治性前列腺切除术的 149 例连续 PCa 患者。根据是否存在 PSM 或 APSM，将患者分为 PSM 组 (n=41) 和无 PSM 组 (n=108)，APSM 组 (n=33) 和无 APSM 组 (n=116)。在 MRI 的 3D 可视化上测量了前列腺顶端形状、PCa 距膜状尿道的距离和耻骨角等 21 个参数。通过多变量逻辑回归分析对显著因素进行分析，建立了列线图模型。
为了预测 PSM 的概率，更长的 PCa 距膜状尿道 (OR=0.136，p=0.019) 和腹膜前至尾骨前缘的距离 (工作空间 AP，OR=0.240，p=0.030) 是独立的保护因素，而 3 型前列腺顶端形状 (OR=8.262，p=0.025) 和更大的耻骨角 2 (OR=5.303，p=0.029) 则是独立的风险因素。列线图模型显示 PSM 的受试者工作特征曲线 (ROC) 下面积 (AUC) 为 0.777。在评估 APSM 的发生率时，我们发现距膜状尿道的距离 (OR=0.135，p=0.014) 与 APSM 发生的风险较低相关，而更大的耻骨角 1 (OR=4.666，p=0.043) 则与 APSM 发生的风险较高相关。列线图模型显示 APSM 的 AUC 为 0.755。
术前 MRI 的 3D 可视化在预测 PSM 或 APSM 方面表现良好，该工具可能具有潜在价值，还需要通过多中心、大规模、前瞻性研究进行验证。
