Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative MRI: A Systematic Review and Meta-Analysis.
Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative MRI: A Systematic Review and Meta-Analysis.
复制标题
MRI 阴性男性中漏诊具有临床意义的前列腺癌的预测因素：系统评价和荟萃分析。
作者：
M. Pagniez;V. Kasivisvanathan;V. Kasivisvanathan;P. Puech;E. Drumez;A. Villers;J. Olivier
目的
系统性综述关于PCA初治患者nMRI后csPCa诊断预测因素的文献。
证据获取
检索了截至2019年3月的Medline和Scopus数据库。审查方案已在PROSPERO数据库（CRD 42019125549）中发表。研究的临床因素和标志物包括年龄、PSA、PSA亚型、PSA密度（PSAD）、PCA 3、前列腺体积、家族史、种族和风险计算器。主要目的是确定其对csPCa诊断的预测能力。次要目的包括结合这些预测因素对nMRI的NPV进行荟萃分析。
证据合成
共有16项研究符合入选条件。很少有研究报告MRI结合标记物的NPV。PSAD是研究最充分的，也是nMRI男性中csPCa的最强预测因子。8项研究（1015例患者）符合PSAD<0.15 ng/ml/ml对MRI降低缺失csPCa风险的附加值的荟萃分析。当与PSAD结合时，癌症初治患者的总体MRI NPV从84.4%增加到90.4%。初治活检亚组从82.7%增加到88.7%，既往阴性活检亚组从88.2%增加到94.1%。
结论
在存在nMRI的情况下使用PSAD<0.15 ng/ml/ml是识别可以避免活检的无csPCa男性的最有用因素。
OBJECTIVE
To systematically review the literature on predictive factors for csPCa diagnosis after nMRI in PCa-naïve patients.
EVIDENCE ACQUISITION
The Medline and Scopus databases were searched up to March 2019. The review protocol was published in the PROSPERO database (CRD42019125549). The clinical factors and markers studied were age, PSA, PSA isoforms, PSA density (PSAD), PCA3, prostate volume, family history, ethnicity, and risk calculators. The primary objective was to determine their predictive ability for csPCa diagnosis. Secondary objectives included meta-analysis of the NPV of nMRI when combined with these predictive factors.
EVIDENCE SYNTHESIS
A total of 16 studies were eligible for inclusion. Few studies reported NPV of MRI combined with a marker. PSAD was the best studied and the strongest predictor of csPCa in men with nMRI. Eight studies (1015 patients) were eligible for meta-analysis of the added value of PSAD< 0.15ng/ml/ml to MRI in reducing the risk of missing csPCa. When combined with PSAD, overall MRI NPV increased from 84.4% to 90.4% in cancer naïve patients. The increase was from 82.7% to 88.7% in biopsy naïve and from 88.2% to 94.1% in previous negative biopsy sub-groups.
CONCLUSION
The use of PSAD<0.15ng/ml/ml in the presence of a nMRI was the most useful factor to identify men without csPCa who could avoid biopsy.