Development of a model to predict prostate cancer at the apex (PCAP model) in patients undergoing robot-assisted radical prostatectomy
Development of a model to predict prostate cancer at the apex (PCAP model) in patients undergoing robot-assisted radical prostatectomy
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DOI：
10.1007/s00345-019-02905-5
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发表时间：
2020-04-01
影响因子：
3.4
通讯作者：
Tewari, Ash
中科院分区：
文献类型：
--
作者：
Cumarasamy, Shivaram;Martini, Alberto;Tewari, Ash
目的建立基于术前变量的根尖前列腺癌预测模型。方法对2016年1月至2017年9月期间接受机器人辅助根治性前列腺切除术（RALP）的459例患者进行回顾性分析。所有患者术前均行前列腺活检和mpMRI检查。显著根尖病理（SAP）定义为顶端有显性结节且Gleason评分为bb0.6和/或顶端ECE的患者。采用二元logistic回归分析预测SAP。模型变量包括PSA、根尖病变前列腺影像学报告和数据系统（PI-RADS）评分和根尖活检Gleason评分。计算了模型的曲线下面积（AUC）。结果121例（43.2%）患者发生SAP，单变量分析中，所有顶点特异性变量均可作为SAP的预测因子（p < 0.05）。在多变量分析中，PSA和根尖PI-RADS评分>.3（均p < 0.05）成为SAP的显著预测因子，模型的AUC为0.722。结论PI-RADS值为3、4或5的患者发生真SAP的可能性是PI-RADS值< 3或行RALP前mpMRI阴性患者的3倍。
Purpose To develop a model based on preoperative variables to predict apical prostate cancer. Methods We performed a retrospective analysis of 459 patients who underwent a robotic assisted radical prostatectomy (RALP) between January 2016 and September 2017. All patients had a preoperative biopsy and mpMRI of the prostate. Significant apical pathology (SAP) was defined as those patients who had a dominant nodule at the apex with a Gleason score > 6 and/or ECE at the apex. Binary logistic regression analyses were adopted to predict SAP. Variables included in the model were PSA, apical lesions prostate imaging reporting and data system (PI-RADS) score and apical biopsy Gleason score. The area under the curve (AUC) of the model was computed. Results A total of 121 (43.2%) patients had SAP. On univariable analysis, all apex-specific variables investigated emerged as predictors of SAP (all p < 0.05). On multivariable analysis PSA and apical PI-RADS score > 3 (all p < 0.05) emerged as significant predictors of SAP. The AUC of the model was 0.722. Conclusion Patients with PI-RADS 3, 4 or 5 lesions at the apex were three times as more likely to have true SAP compared to those who have PI-RADS < 3 or negative mpMRI prior to undergoing RALP.