术前 PI-RADS 评估对接受根治性前列腺切除术患者病理结果的影响。
Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy.
机构信息
Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
National Center for Quality Control of Radiology, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
出版信息
Cancer Imaging. 2023 Nov 26;23(1):113. doi: 10.1186/s40644-023-00619-x.
OBJECTIVE
To assess the effect of preoperative MRI with standardized Prostate Imaging-Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP).
PATIENTS AND METHODS
This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3-4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed.
RESULTS
A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3-4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3-4 (p < 0.001) in the cT1-2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089).
CONCLUSIONS
Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSM rate compared with non-PI-RADS assessment.
目的
评估接受根治性前列腺切除术（RP）的前列腺癌（PCa）患者术前磁共振成像（MRI）联合标准化前列腺影像报告和数据系统（PI-RADS）评估对病理结果的影响。
患者与方法
本回顾性队列研究纳入了 2017 年 1 月至 2022 年 12 月期间因 PCa 行前列腺 MRI 检查和后续 RP 的患者。根据术前 MRI 评估方案，将患者分为 PI-RADS 组和非 PI-RADS 组。回顾并分析了术前特征和术后结局。病理结果包括病理 T 分期（pT2 与 pT3-4）和阳性切缘（PSM）。根据术前有统计学意义的变量进一步分层，评估病理结局的差异。还基于上述术前特征进行了倾向评分匹配。
结果
共纳入 380 例患者，其中 PI-RADS 组 201 例，非 PI-RADS 组 179 例。两组患者的术前特征相似，除临床 T 分期（cT）外。在病理结果方面，PI-RADS 组 pT3-4 比例明显更低（21.4% vs. 48.0%，p<0.001），PSM 比例更低（31.3% vs. 40.9%，p=0.055），cT 与 pT 的一致性更高（79.1% vs. 64.8%，p=0.003）。在 cT1-2 亚组和倾向评分匹配后队列中，PI-RADS 组的 pT3-4 比例也更低（p<0.001）。PI-RADS 组 cT3 患者的 PSM 率降低了 39.2%，但无统计学意义（p=0.089）。
结论
与非 PI-RADS 评估相比，术前 MRI 联合标准化 PI-RADS 评估可通过降低 RP 后病理证实的非器官受限 PCa 发生率来帮助患者做出决策，并略微降低 PSM 率。
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