Magnetic Resonance Imaging-Guided Biopsy in Active Surveillance of Prostate Cancer.
Magnetic Resonance Imaging-Guided Biopsy in Active Surveillance of Prostate Cancer.
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磁共振成像引导活检在前列腺癌主动监测中的应用。
DOI：
10.1097/ju.0000000000002343
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发表时间：
2022-04
影响因子：
6.6
通讯作者：
Marks, Leonard S.
中科院分区：
文献类型：
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作者：
Kinnaird, Adam;Yerram, Nitin K.;O'Connor, Luke;Brisbane, Wayne;Sharma, Vidit;Chuang, Ryan;Jayadevan, Rajiv;Ahdoot, Michael;Daneshvar, Michael;Priester, Alan;Delfin, Merdie;Tran, Elizabeth;Barsa, Danielle E.;Sisk, Anthony;Reiter, Robert E.;Felker, Ely;Raman, Steve;Kwan, Lorna;Choyke, Peter L.;Merino, Maria J.;Wood, Bradford J.;Turkbey, Baris;Pinto, Peter A.;Marks, Leonard S.
前列腺癌主动监测（AS）的基本前提是在癌症相关疾病发生之前识别并消除可能转移的癌症。我们的研究旨在确定在入组前和AS期间使用磁共振成像（MRGBx）引导的活检时前列腺癌升级率。该队列包括2008年2月至2020年2月期间参加前瞻性研究（NCT 00949819和NCT 00102544）的519名低风险或中等风险前列腺癌男性。受试者初步诊断为Gleason分级组（GG）1癌症;当随后的MRGBx证实为GG 1或GG 2时开始AS。参与者接受了确认性MRGBx（靶向和系统性），然后大约每12至24个月进行一次MRGBx监测。主要结局为肿瘤升级至≥ GG 3。在确证性MRGBx后中位随访4.8年（IQR 3.1-6.5）后，92例男性的GBG升高至≥ GG 3。5年后无升级概率为0.85（95% CI 0.81-0.88）。在确诊MRGBx的磁共振成像病变中检测到癌症增加了AS期间后续升级的风险（HR 2.8; 95% CI 1.3-6.0），GG 2的存在也增加了AS期间升级≥ GG 3的男性（HR 2.9; 95% CI 1.1e8.2），仅27%的患者通过靶向核心检测到升级，仅25%的患者通过系统核心检测到升级，两者均为47%。在63例接受直肠癌切除术的男性中，仅5例（8%）从MRGBx升级。当AS开始并伴随MRGBx（靶向和系统性）时，当肿瘤最初存在于磁共振成像病变内或病理学为GG 2时，升级率（≥ GG 3）大于不存在这些特征时。主动监测（AS）已成为管理低风险前列腺癌（PCa）男性的首选策略。改进的进入和随访标准可以帮助消除那些注定需要积极治疗的男性，并在监测期间确定那些进展的剩余男性。在大多数AS项目中，男性是根据超声引导活检（USGBx）显示1级（GG）PCa进入的。然而，部分由于USGBx的局限性，因此活检的许多男性最终将表现出风险增加的PCa，并需要积极治疗。采用磁共振成像（MRGBx）引导的活检提供了比USGBx更准确的前列腺病理学特征。因此，在入组前和AS期间使用MRGBx越来越受到男性的关注。我们研究了2008年2月至2020年2月期间参加前瞻性研究的519名患有低风险或中等风险PCa的AS男性。所有男性均接受了确证性MRGBx（靶向和系统性），随后约每24个月进行一次MRGBx监测。我们发现，在磁共振成像（MRI）中检测到的癌症-在确诊的MRGBx可见病变增加了AS期间随后升级的风险，GG 2的存在也是如此（见图）。在AS后接受腰椎切除术的男性中，仅8%的人发现最近的MRGBx升级。局限性包括缺乏经USGBx确认和随访的男性对照组，结果来自2家具有MRGBx深入经验的中心，可能限制了普遍性。当AS开始并伴随MRGBx（靶向和系统性）时，当肿瘤最初存在于MRI可见病变内或病理学为GG 2时，升级率（≥ GG 3）大于不存在这些特征时。图.在MRI引导的确证性活检显示无癌症（蓝色）、GG 1（红色）或GG 2（绿色）后，PCa AS期间未升级至≥ GG 3的概率。
The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. Our study was designed to determine the prostate cancer upgrading rate when biopsy guided by magnetic resonance imaging (MRGBx) is used before entry and during AS. The cohort included 519 men with low- or intermediate-risk prostate cancer who enrolled in prospective studies (NCT00949819 and NCT00102544) between February 2008 and February 2020. Subjects were preliminarily diagnosed with Gleason Grade Group (GG) 1 cancer; AS began when subsequent MRGBx confirmed GG1 or GG2. Participants underwent confirmatory MRGBx (targeted and systematic) followed by surveillance MRGBx approximately every 12 to 24 months. The primary outcome was tumor upgrading to ≥GG3. Upgrading to ≥GG3 was found in 92 men after a median followup of 4.8 years (IQR 3.1–6.5) after confirmatory MRGBx. Upgrade-free probability after 5 years was 0.85 (95% CI 0.81–0.88). Cancer detected in a magnetic resonance imaging lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS (HR 2.8; 95% CI 1.3–6.0), as did presence of GG2 (HR 2.9; 95% CI 1.1e8.2) In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25% and both in 47%. In 63 men undergoing prostatectomy, upgrading from MRGBx was found in only 5 (8%). When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within a magnetic resonance imaging lesion or when pathology is GG2 than when these features are absent. Active surveillance (AS) has become a preferred strategy for managing men with low-risk prostate cancer (PCa). Improved entry and followup criteria could help eliminate men up front who are destined to require active treatment and, during surveillance, identify those remaining men who progress. In most AS programs, men have entered based on an ultrasoundguided biopsy (USGBx) revealing Grade Group (GG) 1 PCa. However, in part because of the limitations of USGBx many men thus biopsied will ultimately exhibit PCa of increased risk and require active treatment. Biopsies employing guidance by magnetic resonance imaging (MRGBx) provide characterization of prostate pathology which is more accurate than USGBx. Thus, use of MRGBx is of increasing interest for men before entry and during AS. We studied a cohort of 519 men on AS with low- or intermediate-risk PCa who enrolled in prospective studies between February 2008 and February 2020. All men underwent confirmatory MRGBx (targeted and systematic), followed by surveillance MRGBx approximately every 24 months. We found that cancer detected in a magnetic resonance imaging (MRI)-visible lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS, as did presence of GG2 (see figure). In men undergoing prostatectomy after AS, upgrading from the most recent MRGBx was found in only 8%. Limitations include lack of a comparator arm of men confirmed and followed with USGBx, and the results are from 2 centers with in-depth experience with MRGBx, potentially limiting generalizability. When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within an MRI-visible lesion or when pathology is GG2 than when these features are absent. Figure. Probability of freedom from upgrading to ≥GG3 during AS of PCa after an MRI-guided confirmatory biopsy that showed no cancer (blue), GG1 (red) or GG2 (green).