Multiparametric MRI Improves Accuracy of Clinical Nomograms for Predicting Extracapsular Extension of Prostate Cancer
Multiparametric MRI Improves Accuracy of Clinical Nomograms for Predicting Extracapsular Extension of Prostate Cancer
复制标题
DOI：
10.1016/j.urology.2015.06.003
复制
发表时间：
2015-08-01
期刊：
影响因子：
2.1
通讯作者：
Kim, Hyung L.
中科院分区：
文献类型：
--
作者：
Feng, Tom S.;Sharif-Afshar, Ali Reza;Kim, Hyung L.
目的比较多参数磁共振成像（MP-MRI）与Partin表和Memorial Sloan-Kettering（MSK）列线图预测前列腺癌囊外浸润（ECE）的准确性，为临床医师评估病理性ECE风险提供工具。进行回归分析，以确定预测ECE。结果33例（29%）患者在MP-MRI上有ECE，而26例（23%）患者在最终病理上有ECE。平均年龄为62.8岁，平均前列腺特异性抗原为8.2 ng/dL。MRI是ECE的一个重要预测因子，与年龄、前列腺特异性抗原、Gleason评分、临床分期和活检阳性率无关。MP-MRI诊断ECE的敏感性、特异性、阳性预测值和阴性预测值分别为84.6%、87.2%、66.7%和94.9%。用于预测ECE的Partin和MSK列线图的曲线下面积分别为0.85和0.86。当将MP-MRI添加到每个列线图中时，曲线下面积分别增加到0.92和0.94。我们提供了一个在线工具，将Partin或MSK诺模图结果与MRI确定的ECE状态相结合，以预测病理性ECE。结论MP-MRI可作为前列腺癌临床分期的辅助手段。MP-MRI提高了现有临床列线图预测病理性ECE的准确性。(C)2015 Elsevier Inc.
OBJECTIVE To compare the accuracy of multiparametric magnetic resonance imaging (MP-MRI) with the Partin tables and Memorial Sloan-Kettering (MSK) nomogram for predicting extracapsular extension (ECE) in prostate cancer and to create a tool for clinicians to estimate pathologic ECE risk.METHODS A retrospective review of 112 patients who underwent 3T MP-MRI of the prostate and radical prostatectomy was performed. Regression analyses were carried out to identify predictors of ECE. Predictive accuracy of models based on nomogram and MP-MRI were compared.RESULTS A total of 33 of patients (29%) had ECE on MP-MRI whereas 26 patients (23%) had ECE on final pathology. Mean age was 62.8 years and mean prostate-specific antigen was 8.2 ng/dL. MRI was a significant predictor of ECE that was independent of age, prostate-specific antigen, Gleason score, clinical stage, and percent positive cores on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for ECE were 84.6%, 87.2%, 66.7%, and 94.9%, respectively. Areas under the curve for Partin and MSK nomograms for predicting ECE were 0.85 and 0.86, respectively. Area under the curve increased to 0.92 and 0.94, respectively, when MP-MRI was added to each nomogram. We provide an online tool that integrates Partin or MSK nomogram results with ECE status determined from MRI to predict pathologic ECE. Within the typical range of risks for ECE provided by the clinical nomograms (ie, 15%-40%), MRI was useful for predicting pathologic ECE.CONCLUSION MP-MRI may be a useful adjunct for clinically staging prostate cancer. MP-MRI improved accuracy of existing clinical nomograms for prediction of pathologic ECE. (C) 2015 Elsevier Inc.