Nguyen Ngoc-Nhu Jennifer, Liu Kristen, Lajkosz Katherine, Bernardino Rui, Yin Leyi Bellinda, Hollemans Eva, Kroon Lisa J, Fleshner Neil, van Leenders Geert J L H, Iczkowski Kenneth A, van der Kwast Theodorus H, Downes Michelle R
Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Anatomic Pathology, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Mod Pathol. 2025 Jul 25;38(12):100852. doi: 10.1016/j.modpat.2025.100852.
Current prostate cancer risk stratification tools are not adapted for magnetic resonance imaging (MRI)-targeted biopsies and do not include the presence of cribriform carcinoma/intraductal carcinoma (CC/IDC), an independent predictor of adverse clinical outcomes. We developed an MRI-adapted prostate cancer risk tool (MAPCaRT), which incorporates CC/IDC presence to the Cancer of the Prostate Risk Assessment (CAPRA) tool. We compared the prognostic power of MAPCaRT with that of CAPRA in MRI-targeted biopsies (n = 266, 2015-2023) and systematic-only biopsies (n = 1291, 2010-2018) that had matched radical prostatectomy. MAPCaRT employs the aggregate core count method for MRI-targeted lesions to calculate percent positive biopsy cores and uses the radiological stage when assessing MRI-targeted biopsies. Point attribution for CC/IDC presence and Gleason score was determined using a Cox proportional hazards model that included the CAPRA score, Gleason score, and CC/IDC status. Based on calculated MAPCaRT and CAPRA scores, patients were classified into the low-risk (0-2), intermediate-risk (3-5), or high-risk (6+) group. Model performance was assessed via the Kaplan-Meier curves, Harrell C-indices, and decision curve analysis for biochemical recurrence-free survival (BCR-FS) and event-free survival (EFS) (metastasis/cancer-specific death). CC/IDC was present in 84 of 266 (32%) MRI-targeted biopsies and 293 of 1291 systematic-only biopsies (23%). The median follow-up time was 3.4 years (IQR, 2.3-5.5 years) for the MRI-targeted biopsy cohort and 5.9 years (IQR, 3.4-8.1 years) for the systematic biopsy cohort. In the MRI-targeted biopsy cohort, MAPCaRT showed substantial improvement of the C-index compared with CAPRA (0.635 vs 0.574, P = .045) and greater net clinical benefit for 4-year BCR-FS. In the systematic biopsy cohort, MAPCaRT demonstrated improved C-index for BCR-FS (0.696 vs 0.655, P < .001) and greater net clinical benefit for 5-year BCR-FS and EFS. Other model performance metrics were marginally better with MAPCaRT. In summary, we developed MAPCaRT (prostatecancercalculator.lmp.utoronto.ca), a modified version of CAPRA incorporating CC/IDC presence, which demonstrated improved BCR-FS and EFS predictions. This may result in better clinical guidance for disease management decisions.
当前的前列腺癌风险分层工具并不适用于磁共振成像（MRI）靶向活检，且未将筛状癌/导管内癌（CC/IDC）的存在纳入其中，而CC/IDC是不良临床结局的独立预测因素。我们开发了一种适用于MRI的前列腺癌风险工具（MAPCaRT），它将CC/IDC的存在纳入前列腺癌风险评估（CAPRA）工具中。我们比较了MAPCaRT与CAPRA在MRI靶向活检（n = 266，2015 - 2023年）和单纯系统活检（n = 1291，2010 - 2018年）且已进行匹配根治性前列腺切除术的患者中的预后能力。MAPCaRT采用汇总核心计数法对MRI靶向病变进行计算，以得出活检阳性核心百分比，并在评估MRI靶向活检时使用放射学分期。使用包含CAPRA评分、Gleason评分和CC/IDC状态的Cox比例风险模型来确定CC/IDC存在和Gleason评分的点归因。根据计算出的MAPCaRT和CAPRA评分，将患者分为低风险（0 - 2）、中风险（3 - 5）或高风险（6 +）组。通过Kaplan - Meier曲线、Harrell C指数以及生化无复发生存期（BCR - FS）和无事件生存期（EFS，转移/癌症特异性死亡）的决策曲线分析来评估模型性能。在266例MRI靶向活检中有84例（32%）存在CC/IDC，在1291例单纯系统活检中有293例（23%）存在CC/IDC。MRI靶向活检队列的中位随访时间为3.4年（四分位间距，2.3 - 5.5年），系统活检队列的中位随访时间为5.9年（四分位间距，3.4 - 8.1年）。在MRI靶向活检队列中，与CAPRA相比，MAPCaRT的C指数有显著改善（0.635对0.574，P = 0.045），并且在4年BCR - FS方面具有更大的净临床获益。在系统活检队列中，MAPCaRT在BCR - FS方面的C指数有所改善（0.696对0.655，P < 0.001），并且在5年BCR - FS和EFS方面具有更大的净临床获益。MAPCaRT的其他模型性能指标也略好一些。总之，我们开发了MAPCaRT（prostatecancercalculator.lmp.utoronto.ca），这是一种纳入了CC/IDC存在情况的CAPRA改良版本，其在BCR - FS和EFS预测方面表现出改善。这可能会为疾病管理决策带来更好的临床指导。
