Prostate cancer staging: should MR imaging be used?--A decision analytic approach.
Prostate cancer staging: should MR imaging be used?--A decision analytic approach.
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前列腺癌分期：应该使用 MR 成像吗？——决策分析方法。
DOI：
10.1148/radiology.215.2.r00ap09445
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发表时间：
2000
期刊：
影响因子：
19.7
通讯作者：
J. Barentsz
中科院分区：
文献类型：
--
作者：
G. Jager;J. Severens;J. Thornbury;Jean J. M. C. H. de la;Rosette;S. Ruijs;J. Barentsz
目的
确定磁共振（MR）成像在前列腺癌术前分期中的适当应用。
材料和方法
运用循证医学和医疗技术评价的原则进行文献综述。使用决策分析模型比较（a）基于临床分期进行根治性直肠癌切除术的策略与（B）基于临床分期被视为手术候选人的患者在MR成像中检测到囊外疾病禁忌根治性直肠癌切除术的策略。
结果
在回顾文献后，专家小组的意见不建议MR分期。决策分析模型表明，包括MR分期在内的策略降低了成本（磁共振成像，10,568美元;根治性乳房切除术，11,669美元），并导致几乎相同的预期寿命（MR成像，12.59年;根治性直肠癌切除术，12.60年）和质量调整生命年（MR成像，12.53;根治性直肠癌切除术，12.52）。敏感性分析的结果表明，MR策略更有效，成本更低，如果考虑QALY时囊外疾病的先验概率至少为39%，考虑未调整的预期寿命时为50%。
结论
目前还不能最终确定术前MR分期是否合适，但决策分析的结果表明，MR分期对于既往有中度或高度囊外疾病可能性的男性具有成本效益。
PURPOSE
To determine the appropriate use of magnetic resonance (MR) imaging for preoperative staging of prostate cancer.
MATERIALS AND METHODS
Literature review was performed by using the principles of evidence-based medicine and medical technology assessment. A decision analytic model was used to compare (a) the strategy that radical prostatectomy is performed on the basis of clinical staging with (b) the strategy that extracapsular disease detected at MR imaging contraindicates radical prostatectomy in patients who were considered surgical candidates on the basis of clinical staging.
RESULTS
After review of the literature, expert panel opinion did not recommend MR staging. No studies in which therapeutic efficacy was addressed were found. The decision analytic model indicated that the strategy including MR staging decreased costs (MR imaging, $10,568; radical prostatectomy, $11,669) and resulted in almost equal life expectancy (MR imaging, 12.59 years; radical prostatectomy, 12.60 years) and quality-adjusted life-years ([QALYs] MR imaging, 12.53; radical prostatectomy, 12.52). Results of sensitivity analyses demonstrated that the MR strategy was both more effective and less costly if the prior probability of extracapsular disease was at least 39% when considering QALY and 50% when considering unadjusted life expectancy.
CONCLUSION
It is not yet conclusively determined whether preoperative MR staging is appropriate, but results of decision analysis suggest that MR staging is cost-effective for men with moderate or high prior probability of extracapsular disease.
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影响因子：
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