完善前列腺特异性抗原密度的临床相关临界值,对 PI-RADS 3 病变患者进行风险分层。

IF 5.1 2区 医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-07-24 DOI:10.1038/s41391-024-00872-6
Georges Mjaess, Laura Haddad, Teddy Jabbour, Arthur Baudewyns, Henri-Alexandre Bourgeno, Yolène Lefebvre, Mariaconsiglia Ferriero, Giuseppe Simone, Alexandre Fourcade, Georges Fournier, Marco Oderda, Paolo Gontero, Adrian Bernal-Gomez, Alessandro Mastrorosa, Jean-Baptiste Roche, Rawad Abou Zahr, Guillaume Ploussard, Gaelle Fiard, Adam Halinski, Katerina Rysankova, Charles Dariane, Gina Delavar, Julien Anract, Nicolas Barry Delongchamps, Alexandre Patrick Bui, Fayek Taha, Olivier Windisch, Daniel Benamran, Gregoire Assenmacher, Jan Benijts, Karsten Guenzel, Thierry Roumeguère, Alexandre Peltier, Romain Diamand
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引用次数: 0

摘要

背景:前列腺成像报告和数据系统(PI-RADS)3病变是通过多参数磁共振成像(mpMRI)确定的,由于其在预测有临床意义的前列腺癌(csPCa)方面的不确定性,给临床带来了挑战。该研究旨在改进对 PI-RADS 3 病变患者和前列腺活检候选者的风险分层:方法:从独立的前瞻性数据库中回顾性地确定了 2016 年 1 月至 2023 年 4 月间接受磁共振成像及随后接受磁共振成像靶向和系统性活检的 4841 例连续患者。只有 PI-RADS 3 病变的患者才被纳入最终分析。进行了多变量逻辑回归分析,以确定与国际泌尿病理学会(ISUP)分级组≥2的csPCa相关的协变量。使用接收者操作特征曲线下面积 (AUC)、校准和净效益评估了模型的性能。然后使用卡方自动交互检测(CHAID)分析选出重要的预测因子进行进一步探讨:共有 790 名患者有 PI-RADS 3 病变,其中 151 人(19%)患有 csPCa。年龄(OR:1.1 [1.0-1.1];P = 0.01)和 PSA 密度(OR:1643 [2717-41,997];P 结论:PI-RADS 3 级病变的患者中,151 人(19%)患有 csPCa:对于前列腺 mpMRI 显示 PI-RADS 3 病变且 PSAd 低于 0.13(尤其是低于 0.09)的患者,可以不进行前列腺活检,以避免不必要的活检和非前列腺癌的过度诊断。
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Refining clinically relevant cut-offs of prostate specific antigen density for risk stratification in patients with PI-RADS 3 lesions.

Background: Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, identified through multiparametric magnetic resonance imaging (mpMRI), present a clinical challenge due to their equivocal nature in predicting clinically significant prostate cancer (csPCa). Aim of the study is to improve risk stratification of patients with PI-RADS 3 lesions and candidates for prostate biopsy.

Methods: A cohort of 4841 consecutive patients who underwent MRI and subsequent MRI-targeted and systematic biopsies between January 2016 and April 2023 were retrospectively identified from independent prospectively maintained database. Only patients who have PI-RADS 3 lesions were included in the final analysis. A multivariable logistic regression analysis was performed to identify covariables associated with csPCa defined as International Society of Urological Pathology (ISUP) grade group ≥2. Performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Significant predictors were then selected for further exploration using a Chi-squared Automatic Interaction Detection (CHAID) analysis.

Results: Overall, 790 patients had PI-RADS 3 lesions and 151 (19%) had csPCa. Significant associations were observed for age (OR: 1.1 [1.0-1.1]; p = 0.01) and PSA density (OR: 1643 [2717-41,997]; p < 0.01). The CHAID analysis identified PSAd as the sole significant factor influencing the decision tree. Cut-offs for PSAd were 0.13 ng/ml/cc (csPCa detection rate of 1% vs. 18%) for the two-nodes model and 0.09 ng/ml/cc and 0.16 ng/ml/cc for the three-nodes model (csPCa detection rate of 0.5% vs. 2% vs. 17%).

Conclusions: For individuals with PI-RADS 3 lesions on prostate mpMRI and a PSAd below 0.13, especially below 0.09, prostate biopsy can be omitted, in order to avoid unnecessary biopsy and overdiagnosis of non-csPCa.

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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
期刊最新文献
Comprehensive review of cardiovascular disease in prostate cancer: epidemiology, risk factors, therapeutics and prevention strategies. Overcoming barriers to prostate cancer genetic testing: who, when, and how. Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions - an EAU-YAU study enhancing prostate cancer detection. Prostate cancer detection: achieving an optimal balance. Established focal therapy-HIFU, IRE, or cryotherapy-where are we now?-a systematic review and meta-analysis.
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