Prediction of Prostate Cancer Risk Among Men Undergoing Combined MRI-targeted and Systematic Biopsy Using Novel Pre-biopsy Nomograms That Incorporate MRI Findings
Prediction of Prostate Cancer Risk Among Men Undergoing Combined MRI-targeted and Systematic Biopsy Using Novel Pre-biopsy Nomograms That Incorporate MRI Findings
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DOI：
10.1016/j.urology.2017.09.035
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发表时间：
2018-02-01
期刊：
影响因子：
2.1
通讯作者：
Taneja, Samir S.
中科院分区：
文献类型：
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作者：
Bjurlin, Marc A.;Rosenkrantz, Andrew B.;Taneja, Samir S.
目的：在磁共振成像（MRI）靶向、MRI联合靶向和系统前列腺活检中，建立预测总体前列腺癌（PCa）和临床显著性前列腺癌（Gleason >= 7）概率的形态图。材料与方法2012年6月至2014年8月，对464名活检前3T MRI发现可疑区域的男性进行了磁共振超声融合前列腺活检，并进行了系统的12核活检。使用Logistic回归模型来评估总体和临床显著性PCa的预测因子，并生成之前没有活检或之前有过一次或多次阴性活检的男性的相应nomogram。使用随机选择的训练样本的70%创建模型，并使用自举重采样进行偏差校正。然后用剩余的30%测试样本池验证模型。结果共纳入459例患者（中位年龄66岁，前列腺特异性抗原[PSA] 5.2 ng/mL，前列腺体积49 cc）。前列腺特异性抗原（PSA）密度、年龄和MRI怀疑评分是前列腺癌的独立预测因子。使用预测因子为每个队列生成PCa概率图。在训练（测试）样本中，未进行活检的男性总体和临床显著性前列腺癌检测的受试者工作特征曲线下的偏差校正面积分别为0.82（0.78）和0.91(0.84)，而在之前活检为阴性的男性中，偏差校正面积分别为0.76（0.65）和0.86（0.87）。结论PSA密度、年龄和MRI怀疑评分可预测前列腺癌的发生。我们生成的形态图显示出较高的诊断准确性，并可能进一步帮助临床怀疑前列腺癌的男性进行活检的决定。(c) 2017 Elsevier Inc.
OBJECTIVE To develop nomograms that predict the probability of overall prostate cancer (PCa) and clinically significant PCa (Gleason >= 7) on magnetic resonance imaging (MRI)-targeted, and combined MRI-targeted and systematic, prostate biopsy.MATERIALS AND METHODS From June 2012 to August 2014, magnetic resonance imaging to ultrasound fusion-targeted prostate biopsy was performed on 464 men with suspicious regions identified on pre-biopsy 3T MRI along with systematic 12 core biopsy. Logistic regression modeling was used to evaluate predictors of overall and clinically significant PCa, and corresponding nomograms were generated for men who were not previously biopsied or had 1 or more prior negative biopsies. Models were created with 70% of a randomly selected training sample and bias-corrected using bootstrap resampling. The models were then validated with the remaining 30% testing sample pool.RESULTS A total of 459 patients were included for analysis (median age 66 years, prostate-specific antigen [PSA] 5.2 ng/mL, prostate volume 49 cc). Independent predictors of PCa on targeted and systematic prostate biopsy were PSA density, age, and MRI suspicion score. PCa probability nomograms were generated for each cohort using the predictors. Bias-corrected areas under the receiver-operating characteristic curves for overall and clinically significant PCa detection were 0.82 (0.78) and 0.91 (0.84) for men without prior biopsy and 0.76 (0.65) and 0.86 (0.87) for men with a prior negative biopsy in the training (testing) samples.CONCLUSION PSA density, age, and MRI suspicion score predict PCa on combined MRI-targeted and systematic biopsy. Our generated nomograms demonstrate high diagnostic accuracy and may further aid in the decision to perform biopsy in men with clinical suspicion of PCa. (c) 2017 Elsevier Inc.