Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Radiol Med. 2024 Sep;129(9):1394-1404. doi: 10.1007/s11547-024-01857-0. Epub 2024 Jul 16.
To assess the ability of tumor apparent diffusion coefficient (ADC) values obtained from multiparametric magnetic resonance imaging (mpMRI) to predict the risk of 5-year biochemical recurrence (BCR) after radical prostatectomy (RP).
This retrospective analysis included 1207 peripheral and 232 non-peripheral zone prostate cancer (PCa) patients who underwent mpMRI before RP (2012-2015), with the outcome of interest being 5-year BCR. ADC was evaluated as a continuous variable and as categories: low (< 850 µm/s), intermediate (850-1100 µm/s), and high (> 1100 µm/s). Kaplan-Meier curves with log-rank testing of BCR-free survival, multivariable Cox proportional hazard regression models were formed to estimate the risk of BCR.
Among the 1439 males with median age 63 (± 7) years, the median follow-up was 59 months, and 306 (25%) patients experienced BCR. Peripheral zone PCa patients with BCR had lower tumor ADC values than those without BCR (874 versus 1025 µm/s, p < 0.001). Five-year BCR-free survival rates were 52.3%, 74.4%, and 87% for patients in the low, intermediate, and high ADC value categories, respectively (p < 0.0001). Lower ADC was associated with BCR, both as continuously coded variable (HR: 5.35; p < 0.001) and as ADC categories (intermediate versus high ADC-HR: 1.56, p = 0.017; low vs. high ADC-HR; 2.36, p < 0.001). In the non-peripheral zone PCa patients, no association between ADC and BCR was observed.
Tumor ADC values and categories were found to be predictive of the 5-year BCR risk after RP in patients with peripheral zone PCa and may serve as a prognostic biomarker.
评估多参数磁共振成像（mpMRI）获得的肿瘤表观扩散系数（ADC）值预测根治性前列腺切除术（RP）后 5 年生化复发（BCR）的能力。
本回顾性分析纳入了 1207 例外周区和 232 例非外周区前列腺癌（PCa）患者，这些患者在 RP 前（2012-2015 年）进行了 mpMRI，主要研究终点为 5 年 BCR。ADC 作为连续变量和分类变量进行评估：低（<850 µm/s）、中（850-1100 µm/s）和高（>1100 µm/s）。Kaplan-Meier 曲线结合对数秩检验用于评估 BCR 无复发生存率，多变量 Cox 比例风险回归模型用于估计 BCR 的风险。
在中位年龄为 63（±7）岁的 1439 例男性中，中位随访时间为 59 个月，306 例（25%）患者发生 BCR。有 BCR 的外周区 PCa 患者的肿瘤 ADC 值低于无 BCR 的患者（874 µm/s 比 1025 µm/s，p<0.001）。低、中、高 ADC 值组患者的 5 年 BCR 无复发生存率分别为 52.3%、74.4%和 87%（p<0.0001）。较低的 ADC 与 BCR 相关，既可以作为连续编码变量（HR：5.35；p<0.001），也可以作为 ADC 分类（中值与高值 ADC-HR：1.56，p=0.017；低值与高值 ADC-HR：2.36，p<0.001）。在外周区 PCa 患者中，ADC 与 BCR 之间无相关性。
在外周区 PCa 患者中，肿瘤 ADC 值和分类与 RP 后 5 年 BCR 风险相关，可作为一种预后生物标志物。
