D'Amico A V, Whittington R, Schnall M, Malkowicz S B, Tomaszewski J E, Schultz D, Wein A
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia.
Cancer. 1995 May 1;75(9):2368-72. doi: 10.1002/1097-0142(19950501)75:9<2368::aid-cncr2820750929>3.0.co;2-#.
The introduction of the endorectal coil magnetic resonance imaging (MRI) technique has improved the accuracy of preoperative staging for prostate cancer. This study quantifies the improvement in the ability to identify clinically unsuspected extraprostatic disease with the use of the endorectal coil MRI.
A retrospective review of the pathologic findings of 347 patients with prostate cancer treated with a radical retropubic prostatectomy was performed. The preoperative clinical indicators including prostate specific antigen (PSA), clinical stage, Gleason score, and endorectal coil MRI data were employed in a multivariate analysis to identify patients who were at high risk for seminal vesicle invasion (SVI) or extracapsular extension (ECE). The sensitivity, specificity, and positive and negative predictive values for predicting SVI and ECE were calculated using the significant clinical indicators found on the multivariate analysis.
The clinical factors identified on multivariate analysis as significant predictors of SVI include the endorectal coil MRI data (P < 0.0001), PSA (P = 0.0096), and the Gleason score (P = 0.012). Endorectal coil MRI data (P < 0.0001), PSA (P = .0001), and Gleason score (P < .0001) were significant predictors of ECE. In the patient subgroup with PSA (> 10-20 ng/ml) and Gleason score of 5 to 7, the addition of the endorectal coil MRI data enabled an additional 71 and 27% of patients with SVI and ECE, respectively, to be correctly identified. These patients would have been missed based on the prediction obtained from the PSA and Gleason score alone.
The use of the endorectal coil magnetic resonance imaging data, in addition to prostate specific antigen and Gleason score, provides a more accurate prediction of the pathologic outcome of seminal vesicle invasion and extracapsular extension than the PSA and Gleason score alone for the patient subgroup with a PSA of greater than 10 to 20 ng/ml and Gleason score of 5 to 7.
直肠内线圈磁共振成像（MRI）技术的引入提高了前列腺癌术前分期的准确性。本研究量化了使用直肠内线圈MRI识别临床上未怀疑的前列腺外疾病能力的提高。
对347例行耻骨后根治性前列腺切除术的前列腺癌患者的病理结果进行回顾性分析。术前临床指标包括前列腺特异性抗原（PSA）、临床分期、Gleason评分和直肠内线圈MRI数据，用于多因素分析以识别精囊侵犯（SVI）或包膜外扩展（ECE）的高危患者。使用多因素分析中发现的显著临床指标计算预测SVI和ECE的敏感性、特异性以及阳性和阴性预测值。
多因素分析中确定为SVI显著预测因素的临床因素包括直肠内线圈MRI数据（P < 0.0001）、PSA（P = 0.0096）和Gleason评分（P = 0.012）。直肠内线圈MRI数据（P < 0.0001）、PSA（P = 0.0001）和Gleason评分（P < 0.0001）是ECE的显著预测因素。在PSA（> 10 - 20 ng/ml）且Gleason评分为5至7的患者亚组中，添加直肠内线圈MRI数据分别使另外71%和27%的SVI和ECE患者被正确识别。仅根据PSA和Gleason评分进行预测，这些患者将会被漏诊。
对于PSA大于10至20 ng/ml且Gleason评分为~5至7的患者亚组，除了前列腺特异性抗原和Gleason评分外，使用直肠内线圈磁共振成像数据比单独使用PSA和Gleason评分能更准确地预测精囊侵犯和包膜外扩展的病理结果。
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