背景:在大型队列研究中尚未检查pT3a前列腺癌的多参数MRI(mpMRI)参数。因此,我们的目的是在术后组织病理学确认中确定与mpMRIcT3a分期相关的因素.
方法:对一个英国癌症中心前瞻性维护的数据库进行回顾性分析。仅包括接受机器人辅助根治性前列腺切除术(RARP)的cT3a病例(N=383)。MRI和标本组织病理学由放射科专家和组织病理学专家独立审查。分别。因素包括年龄,BMI,前列腺特异性抗原(PSA)水平,活检国际泌尿外科病理学会(ISUP)分级,前列腺成像报告和数据系统(PI-RADS®)评分,肿瘤大小,腺体肿瘤覆盖率(%),分析腺体重量和手术切缘作为pT3a前列腺癌的预测因子。
结果:N=383。平均年龄66岁(58-71岁),平均BMI27.1kg/m2(25.0-30.0)。314例(82.0%)下降-不变或下降,和69(18.0%)例上升。PSA水平(P=0.002),PI-RADS评分(P<0.001)和ISUP等级(P<0.001)与升级类别呈正相关。ISUP等级≥3(OR5.45,CI1.88,9.29,P<0.002),PI-RADS评分≥4(OR3.92,CI1.88-9.29,P<0.001)和肿瘤覆盖率(OR1.06,CI1.05-1.08,P<0.001)与疾病升级呈显著正相关,同时降低分期的概率(OR分别为0.55、0.14、0.44,P<0.05)。肿瘤覆盖率与手术切缘阳性增加呈正相关(P<0.05)。>15mm的囊间接触极不可能升级(OR0.36,CI0.21-0.62,P<0.001),与已发表的MRI囊外疾病的广泛接受显着水平的结果一致。
结论:该研究确定了PSA水平,ISUP,PI-RADS评分,肿瘤体积和覆盖率是cT3a分期的关键预测因素。这项研究独特地显示了肿瘤覆盖率作为mpMRI上cT3a升级的预测指标。ISUP是最强的预测因子,其次是PI-RADS评分和腺体肿瘤覆盖率。需要多机构研究来证实我们的发现。
BACKGROUND: Multiparametric MRI (mpMRI) parameters of pT3a prostate cancer have not been examined in large cohort studies. Therefore, we aimed to identify factors associated with up-staging of mpMRI cT3a in post-operative histopathological confirmation.
METHODS: Retrospective analysis of a prospectively maintained database of a single UK cancer centre. Only cT3a cases who underwent robotic-assisted radical prostatectomy (RARP) were included (N = 383). MRI and specimen histopathology was reviewed independently by expert uro-radiologists and uro-histopathologists, respectively. Factors included age, BMI, prostate-specific antigen (PSA) level, biopsy international society of urological pathology (ISUP) grade, Prostate Imaging Reporting & Data System (PI-RADS®) score, tumour size, tumour coverage of gland (%), gland weight and surgical margins were analysed as predictors of pT3a prostate cancer.
RESULTS: N = 383. Mean age 66 years (58-71), mean BMI 27.1 kg/m2 (25.0-30.0). 314 (82.0%) cases down- unchanged or down-staged, and 69 (18.0%) cases upstaged. PSA level (P = 0.002), PI-RADS score (P < 0.001) and ISUP grade (P < 0.001) are positively associated with upstage categories. ISUP grade ≥3 (OR 5.45, CI 1.88, 9.29, P < 0.002), PI-RADS score ≥4 (OR 3.92, CI 1.88-9.29, P < 0.001) and tumour coverage (OR 1.06, CI 1.05-1.08, P < 0.001) significantly positively associated with upstaging disease, with concurrent decreased probability of downstaging (OR 0.55, 0.14, 0.44, respectively, P < 0.05). Tumour coverage was positively correlated with increasing positive surgical margins (P < 0.05). Capsular contact > 15 mm was very unlikely to be upstaged (OR 0.36, CI 0.21-0.62, P < 0.001), aligning with published results past the widely accepted significant level for extracapsular disease on MRI.
CONCLUSIONS: The study has identified PSA level, ISUP, PI-RADS score, tumour volume and percentage coverage are key predictive factors in cT3a upstaging. This study uniquely shows tumour coverage percentage as a predictor of cT3a upstaging on mpMRI. ISUP is the strongest predictor, followed by PI-RADS score and tumour coverage of gland. Multi-institutional studies are needed to confirm our findings.