Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy.
Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy.
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DOI：
10.1016/j.eururo.2022.02.022
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发表时间：
2022-06
期刊：
影响因子：
23.4
通讯作者：
Ahmed, Hashim U.
中科院分区：
文献类型：
--
作者：
Shah, Taimur T.;Kanthabalan, Abi;Otieno, Marjorie;Pavlou, Menelaos;Omar, Rumana;Adeleke, Sola;Giganti, Francesco;Brew-Graves, Chris;Williams, Norman R.;Grierson, Jack;Miah, Haroon;Emara, Amr;Haroon, Athar;Latifoltojar, Arash;Sidhu, Harbir;Clemente, Joey;Freeman, Alex;Orczyk, Clement;Nikapota, Ashok;Dudderidge, Tim;Hindley, Richard G.;Virdi, Jaspal;Arya, Manit;Payne, Heather;Mitra, Anita;Bomanji, Jamshed;Winkler, Mathias;Horan, Gail;Moore, Caroline M.;Emberton, Mark;Punwani, Shonit;Ahmed, Hashim U.
关键词：
放疗后复发的前列腺癌发生在五分之一的患者中。前列腺磁共振成像（MRI）在复发性癌症中的疗效尚未确定。此外，还需要关于新的微创挽救性局灶消融治疗的高质量数据。探讨前列腺MRI在前列腺癌放疗后复发诊断中的作用。FORECAST试验是一项评价前列腺多参数MRI（mpMRI）和MRI靶向活检检测复发性癌症的配对队列诊断研究，也是一项评价6家英国中心局灶性消融的队列研究。共招募了181例患者，其中155例纳入MRI分析，93例纳入局灶性消融分析。患者接受胆碱正电子发射断层扫描/计算机断层扫描和骨扫描，然后进行前列腺mpMRI和MRI靶向和经会阴模板映射（TTPM）活检。据报告，MRI对其他检查设盲。合格患者随后接受了局灶性消融。2014年12月的一项修正案允许在转移瘤患者中进行局灶性消融。主要结果是MRI和MRI靶向活检对癌症检测的敏感性，以及局灶消融后的尿失禁。一个关键的次要结局是无进展生存期（PFS）。分期全身成像显示128名患者（71%）局部癌症，仅13名（7%）盆腔淋巴结受累，38名（21%）转移。MRI靶向活检的敏感性为92%（95%置信区间[CI] 83-97%）。特异性、阳性和阴性预测值分别为75%（95% CI 45-92%）、94%（95% CI 86-98%）和65%（95% CI 38-86%）。TTPM活检漏诊4例（6%），MRI靶向活检漏诊6例（8%）。MRI检测任何癌症的总体灵敏度为94%（95% CI 88-98%）。特异性、阳性和阴性预测值分别为18%（95% CI 7-35%）、80%（95% CI 73-87%）和46%（95% CI 19-75%）。在接受局灶消融术的93例患者中，15例（16%）发生尿失禁，5例（5%）发生≥3级不良事件，无直肠损伤。中位随访时间为27个月（四分位距18-36）; 24个月时总体PFS为66%（四分位距54-75%）。患者应接受前列腺MRI检查，同时进行系统性和靶向活检，以优化癌症检测。前列腺内复发区域的局灶性消融保留了大多数前列腺切除术，并具有良好的早期癌症控制。我们研究了前列腺磁共振成像（MRI）扫描和MRI靶向活检在癌症靶向高强度超声或冷冻治疗放疗后复发性癌症患者预后中的作用。我们的研究结果表明，这些患者应该接受前列腺MRI检查，同时进行系统性和靶向活检，然后对复发性癌症区域进行消融治疗，以保持他们的生活质量。
Recurrent prostate cancer after radiotherapy occurs in one in five patients. The efficacy of prostate magnetic resonance imaging (MRI) in recurrent cancer has not been established. Furthermore, high-quality data on new minimally invasive salvage focal ablative treatments are needed. To evaluate the role of prostate MRI in detection of prostate cancer recurring after radiotherapy. The FORECAST trial was both a paired-cohort diagnostic study evaluating prostate multiparametric MRI (mpMRI) and MRI-targeted biopsies in the detection of recurrent cancer and a cohort study evaluating focal ablation at six UK centres. A total of 181 patients were recruited, with 155 included in the MRI analysis and 93 in the focal ablation analysis. Patients underwent choline positron emission tomography/computed tomography and a bone scan, followed by prostate mpMRI and MRI-targeted and transperineal template-mapping (TTPM) biopsies. MRI was reported blind to other tests. Those eligible underwent subsequent focal ablation. An amendment in December 2014 permitted focal ablation in patients with metastases. Primary outcomes were the sensitivity of MRI and MRI-targeted biopsies for cancer detection, and urinary incontinence after focal ablation. A key secondary outcome was progression-free survival (PFS). Staging whole-body imaging revealed localised cancer in 128 patients (71%), with involvement of pelvic nodes only in 13 (7%) and metastases in 38 (21%). The sensitivity of MRI-targeted biopsy was 92% (95% confidence interval [CI] 83–97%). The specificity and positive and negative predictive values were 75% (95% CI 45–92%), 94% (95% CI 86–98%), and 65% (95% CI 38–86%), respectively. Four cancer (6%) were missed by TTPM biopsy and six (8%) were missed by MRI-targeted biopsy. The overall MRI sensitivity for detection of any cancer was 94% (95% CI 88–98%). The specificity and positive and negative predictive values were 18% (95% CI 7–35%), 80% (95% CI 73–87%), and 46% (95% CI 19–75%), respectively. Among 93 patients undergoing focal ablation, urinary incontinence occurred in 15 (16%) and five (5%) had a grade ≥3 adverse event, with no rectal injuries. Median follow-up was 27 mo (interquartile range 18–36); overall PFS was 66% (interquartile range 54–75%) at 24 mo. Patients should undergo prostate MRI with both systematic and targeted biopsies to optimise cancer detection. Focal ablation for areas of intraprostatic recurrence preserves continence in the majority, with good early cancer control. We investigated the role of magnetic resonance imaging (MRI) scans of the prostate and MRI-targeted biopsies in outcomes after cancer-targeted high-intensity ultrasound or cryotherapy in patients with recurrent cancer after radiotherapy. Our findings show that these patients should undergo prostate MRI with both systematic and targeted biopsies and then ablative treatment focused on areas of recurrent cancer to preserve their quality of life.
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影响因子：
3.6
作者：
Vickers, Andrew J.;Elkin, Elena B.
通讯作者：
Elkin, Elena B.
DOI：
10.1056/nejmoa1801993
发表时间：
2018-05-10
期刊：
The New England journal of medicine
影响因子：
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通讯作者：
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影响因子：
158.5
作者：
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通讯作者：
Castellano, Daniel
影响因子：
8.8
作者：
Simmons, Lucy A. M.;Kanthabalan, Abi;Ahmed, Hashim U.
通讯作者：
Ahmed, Hashim U.
DOI：
10.1016/s1470-2045(16)30102-4
发表时间：
2016-08
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Dearnaley D;Syndikus I;Mossop H;Khoo V;Birtle A;Bloomfield D;Graham J;Kirkbride P;Logue J;Malik Z;Money-Kyrle J;O'Sullivan JM;Panades M;Parker C;Patterson H;Scrase C;Staffurth J;Stockdale A;Tremlett J;Bidmead M;Mayles H;Naismith O;South C;Gao A;Cruickshank C;Hassan S;Pugh J;Griffin C;Hall E;CHHiP Investigators
通讯作者：
CHHiP Investigators