External Validation of a Multiparametric Magnetic Resonance Imaging-based Nomogram for the Prediction of Extracapsular Extension and Seminal Vesicle Invasion in Prostate Cancer Patients Undergoing Radical Prostatectomy
External Validation of a Multiparametric Magnetic Resonance Imaging-based Nomogram for the Prediction of Extracapsular Extension and Seminal Vesicle Invasion in Prostate Cancer Patients Undergoing Radical Prostatectomy
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DOI：
10.1016/j.eururo.2020.09.037
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发表时间：
2021-01-14
期刊：
影响因子：
23.4
通讯作者：
Albisinni, Simone
中科院分区：
文献类型：
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作者：
Diamand, Romain;Ploussard, Guillaume;Albisinni, Simone
Gandaglia等人报告的列线图（多参数磁共振成像、磁共振成像靶向和伴随系统活检预测接受根治性前列腺癌切除术的前列腺癌患者不良病理特征的关键组合价值。2020年欧洲泌尿外科展; 77：733-41），已经使用多参数磁共振成像（MRI）参数和MRI靶向活检开发了预测囊外延伸（ECE）或精囊浸润（SVI）的方法。我们的目的是通过分析566例经MRI靶向活检诊断为前列腺癌并随后行根治性前列腺切除术的患者，从外部验证该列线图。在最终病理学检查时，分别有37%和12%的患者有ECE和SVI。性能的诺模图，在纪念斯隆-凯特琳癌症中心（MSKCC）模型和Partin表相比，进行了评价，使用歧视，校准和决策曲线分析。关于ECE预测，当分别与MSKCC模型和Partin表相比时，列线图显示出更高的区分度（71.8% vs 69.8%，p = 0.3和71.8% vs 61.3%，p < 0.001），以及相似的误校准和概率阈值高于30%的净效益。列线图在SVI方面的表现在区分度方面相当（68.5% vs 70.4% vs 67.8%，p >= 0.6），在校准图上略微高估，概率阈值高于7.5%时净收益。这是第一个多中心研究，外部验证诺模图预测ECE和SVI的患者诊断与MRI靶向活检。其性能不如预期乐观，与现有模型相比，在这种情况下实施MRI与患者选择和临床有用性的明显改善无关。我们提出了一个更新版本的诺模图预测ECE使用重新校准的方法，这导致其性能的改善，需要在另一个外部集进行验证。患者总结：我们验证了一种基于多参数磁共振成像（MRI）参数和MRI靶向活检的预测工具，可预测根治性前列腺切除术中的囊外扩张和精囊浸润。与基于临床参数的现有模型相比，患者选择的改善并未得到明确证明，在这种情况下实施MRI仍需澄清。(C)2020年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
The nomogram reported by Gandaglia et al (The key combined value of multiparametric magnetic resonance imaging, and magnetic resonance imaging-targeted and concomitant systematic biopsies for the prediction of adverse pathological features in prostate cancer patients undergoing radical prostatectomy. Eur Urol 2020;77:733-41) predicting extracapsular extension (ECE) or seminal vesicle invasion (SVI) has been developed using multiparametric magnetic resonance imaging (MRI) parameters and MRI-targeted biopsy. We aimed to validate this nomogram externally by analyzing 566 patients harboring prostate cancer diagnosed on MRI-targeted biopsy followed by radical prostatectomy. At final pathology, 37% and 12% patients had ECE and SVI, respectively. Performance of the nomogram, in comparison with the Memorial Sloan Kettering Cancer Center (MSKCC) model and Partin tables, was evaluated using discrimination, calibration, and decision curve analysis. Regarding ECE prediction, the nomogram showed higher discrimination (71.8% vs 69.8%, p = 0.3 and 71.8% vs 61.3%, p < 0.001), and similar miscalibration and net benefit for probability threshold above 30% when compared with MSKCC model and Partin tables, respectively. Performance of the nomogram with regard to SVI was comparable in terms of discrimination (68.5% vs 70.4% vs 67.8%, p >= 0.6), presenting a slight overestimation on calibration plots and a net benefit for probability threshold above 7.5%. This is the first multicentric study that externally validates a nomogram predicting ECE and SVI in patients diagnosed with MRI-targeted biopsy. Its performance was less optimistic than expected, and implementation of MRI in this setting was not associated with a clear improvement in patient selection and clinical usefulness when compared with available models. We proposed an updated version of the nomogram predicting ECE using the recalibration method, which leads to an improvement in its performance and needs to be validated in another external set. Patient summary: We validate a prediction tool based on multiparametric magnetic resonance imaging (MRI) parameters and MRI-targeted biopsy predicting extracapsular extension and seminal vesicle invasion at radical prostatectomy. An improvement of patient selection was not clearly demonstrated when compared with available models based on clinical parameters, and implementation of MRI in this setting still needs to be clarified. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.