Oncologic Outcomes after Localized Prostate Cancer Treatment: Associations with Pretreatment Prostate Magnetic Resonance Imaging Findings.
Oncologic Outcomes after Localized Prostate Cancer Treatment: Associations with Pretreatment Prostate Magnetic Resonance Imaging Findings.
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DOI：
10.1097/ju.0000000000001474
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
Vargas HA
中科院分区：
文献类型：
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作者：
Wibmer AG;Chaim J;Lakhman Y;Lefkowitz RA;Nincevic J;Nikolovski I;Sala E;Gonen M;Carlsson SV;Fine SW;Zelefsky MJ;Scardino P;Hricak H;Vargas HA
研究T2加权磁共振成像（MRI）结果是否可以改善转移性疾病和癌症特异性生存率的既定预后指标。在2001年至2006年期间，3，406名在明确的前列腺切除术（n= 2，160）或放疗（n= 1，246）之前接受前列腺MRI的连续男性队列中，回顾性解释T2加权MRI检查并分类为（I）无局灶性可疑病变;（II）器官局限性局灶性病变;（III）局灶性病变伴前列腺外延伸;或（IV）局灶性病变侵犯精囊。根据欧洲泌尿外科协会（EAU）指南和前列腺癌风险评估（CAPRA）评分系统记录临床风险。分别使用考克斯模型和逆概率删失权重估计生存概率和c指数。中位随访时间为10.8年（IQR：8.6-13.0年）。MRI分级越高，发生转移的可能性越高（所有MRI分级的风险比：3.5-18.1，p<0.001），前列腺癌死亡的可能性越高（风险比：3.1-29.7，p<0.001-0.025）;这些相关性在统计学上与EAU风险分级、CAPRA评分和治疗类型（手术与放疗）无关。将EAU风险或CAPRA评分与MRI分类相结合，显著改善了转移灶的预测（c指数：EAU：0.798，EAU+MRI：0.872; CAPRA：0.808，CAPRA+MRI：0.877）和前列腺癌死亡（c指数：EAU：0.813，EAU+MRI：0.889; CAPRA：0.814，CAPRA+MRI：0.892）（均p<0.001）。局限性前列腺癌的MRI表现与临床相关的长期肿瘤学结局相关。结合MRI和临床病理学数据，可以更准确地预测，这可能有助于个性化的患者管理。
To investigate whether T2-weighted magnetic resonance imaging (MRI) findings could improve upon established prognostic indicators of metastatic disease and cancer-specific survival. For a cohort of 3,406 consecutive men who underwent prostate MRI before definitive prostatectomy (n=2,160) or radiotherapy (n=1,246) between 2001 and 2006, T2-weighted MRI exams were retrospectively interpreted and categorized as (I) No focal suspicious lesion; (II) organ-confined focal lesion; (III) focal lesion with extraprostatic extension; or (IV) focal lesion with seminal vesicle invasion. Clinical risk was recorded based on European Association of Urology (EAU) guidelines and the Cancer of the Prostate Risk Assessment (CAPRA) scoring system. Survival probabilities and c-indices were estimated using Cox models and inverse probability censoring weights, respectively. The median follow-up was 10.8 years (IQR: 8.6-13.0 years). Higher MRI categories were associated with a higher likelihood of developing metastases (hazard ratios: 3.5-18.1, p<0.001 for all MRI categories) and prostate cancer death (hazard ratios: 3.1-29.7, p<0.001-0.025); these associations were statistically independent of EAU risk categories, CAPRA scores, and treatment type (surgery vs. radiation). Combining EAU risk or CAPRA scores with MRI categories significantly improved prognostication of metastases (c-indices: EAU: 0.798, EAU+MRI: 0.872; CAPRA: 0.808, CAPRA+MRI: 0.877) and prostate cancer death (c-indices: EAU: 0.813, EAU+MRI: 0.889; CAPRA: 0.814, CAPRA+MRI: 0.892) (p<0.001 for all). MRI findings of localized prostate cancer are associated with clinically relevant long-term oncologic outcomes. Combining MRI and clinicopathologic data results in more accurate prognostication, which could facilitate individualized patient management.