Re: Giorgio Gandaglia, Guillaume Ploussard, Massimo Valerio, et al. Prognostic Implications of Multiparametric Magnetic Resonance Imaging and Concomitant Systematic Biopsy in Predicting Biochemical Recurrence After Radical Prostatectomy in Prostate Cancer Patients Diagnosed with Magnetic Resonance Imaging-targeted Biopsy. Eur Urol Oncol 2020;7:739-47.
Re: Giorgio Gandaglia, Guillaume Ploussard, Massimo Valerio, et al. Prognostic Implications of Multiparametric Magnetic Resonance Imaging and Concomitant Systematic Biopsy in Predicting Biochemical Recurrence After Radical Prostatectomy in Prostate Cancer Patients Diagnosed with Magnetic Resonance Imaging-targeted Biopsy. Eur Urol Oncol 2020;7:739-47.
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回复：Giorgio Gandaglia、Guillaume Ploussard、Massimo Valerio 等人。
DOI：
10.1016/j.euo.2020.12.015
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发表时间：
2021
影响因子：
8.2
通讯作者：
Morka N
中科院分区：
文献类型：
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作者：
Morka N
很高兴阅读 Gandalgia 及其同事最近发表的文章，其中他们使用了一种新颖的方法来研究使用多参数磁共振成像 (mpMRI) 和系统活检来预测根治性前列腺切除术后生化复发 (BCR) 的风险 [1]。 mpMRI 已成为前列腺癌诊断和风险分层的核心，取代了主要基于组织病理学特征的预后工具。我们赞扬作者在这项研究中使用了稳健的统计方法，以及他们开发的预测模型的功效，该模型可能具有相当大的临床意义。这项研究还引起了人们对伴随系统活检的潜在益处的关注。然而，我们确实对具体的方法选择提出了一些评论，我们认为这些评论将加强该领域的未来工作。在这里，作者将临床上显着的癌症定义为格里森等级组 (GGG) 2 及以上。然而，越来越多的证据表明，不能仅根据格里森分级来确定临床意义 [2, 3]。事实上，越来越需要考虑肿瘤体积和 Gleason 4 模式百分比之间的相互作用。 Frankcombe 等人的研究结果很好地说明了这一点。[3]他们证明，当 Gleason 4 模式的百分比较低时，两个不同体积组（≤ 2mL 和 > 2mL）的中危疾病具有相似的 BCR 风险，但在较高百分比（≥ 30%）时，体积组之间的 BCR 风险存在统计学显着差异（p < 0.001）。因此，当将临床风险和 MRI 显着性归因于特定肿瘤时，承认肿瘤体积似乎是相关的。
It was a pleasure to read the recent article by Gandalgia and colleagues, in which they used a novel approach to study the use of both multiparametric magnetic resonance imaging (mpMRI) and systematic biopsy to predict the risk of biochemical recurrence (BCR) following radical prostatectomy [1]. mpMRI has become central to prostate cancer diagnosis and risk stratification, replacing prognostic tools based primarily on histopathological features. We commend the authors on their use of robust statistical methods in this study, and the efficacy of their developed predictive model that potentially has considerable clinical significance. This study also draws attention to the potential benefit of an accompanying systematic biopsy. We do, however, offer some comments on specific methodological choices which we feel would strengthen future work in this area.Here, the authors defined clinically significant cancer as Gleason Grade Group (GGG) 2 and above. However, there is an increasing body of evidence suggesting that clinical significance cannot be ascertained based on Gleason grade alone [2, 3]. Indeed, there is increasing need to consider the interplay between tumour volume and the percentage of Gleason 4 pattern. This is well illustrated by the findings of Frankcombe et al.[3] who demonstrated that two different volume groups (≤ 2mL and> 2mL) of intermediate risk disease had a similar risk of BCR when the percentage of Gleason 4 pattern was low, yet at higher percentages (≥ 30%), there was a statistically significant difference in the risk of BCR between the volume groups (p< 0.001). Therefore, when attributing clinical risk and MRI conspicuity to a given tumour, it seems pertinent to acknowledge tumour volume.