接受根治性前列腺切除术的男性前列腺癌患者 PI-RADS 评分的预后意义。

IF 1.5 Q3 UROLOGY & NEPHROLOGY American journal of clinical and experimental urology Pub Date : 2024-08-25 eCollection Date: 2024-01-01 DOI:10.62347/BODM5001
Julum Nwanze, Yuki Teramoto, Ying Wang, Hiroshi Miyamoto
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引用次数: 0

摘要

目的:前列腺成像报告和数据系统(PI-RADS)评估类别有用的磁共振成像靶向活检(T-Bx)已被证明能更准确地检测出有临床意义的前列腺癌。然而,PI-RADS 对前列腺癌患者的预后意义还需要进一步研究。在本研究中,我们比较了因PI-RADS 3 vs. 4 vs. 5病变而初次接受T-Bx手术的男性前列腺癌患者的根治性前列腺切除术结果和术后肿瘤学预后:我们评估了接受T-Bx手术并同时进行系统活检(S-Bx),然后进行前列腺癌根治术的连续患者。在我们的外科病理数据库中,我们共发现了207名男性患者,他们在S-Bx或T-Bx或两者中均发现了前列腺腺癌:结果:仅在S-Bx(32人,占15%)、T-Bx(39人,占19%)或S-Bx和T-Bx(136人,占66%)上发现前列腺癌。这些患者的病灶为 PI-RADS 3(n = 42;20%)、4(n = 86;42%)或 5(n = 79;38%),而 T-Bx 检测出癌症的病例为 PI-RADS 3 的 31 例(74%)、PI-RADS 4 的 72 例(84%)和 PI-RADS 5 的 72 例(91%)。PI-RADS 3 组与 PI-RADS 4 组和 PI-RADS 5 组的临床病理特征(包括活检或前列腺切除术的肿瘤分级以及 pT 或 pN 分期)均无明显差异,但 PI-RADS 5 组的肿瘤边缘阳性率明显高于 PI-RADS 3 组,肿瘤体积明显大于 PI-RADS 3 组。单变量和多变量分析显示,PI-RADS 5病变患者前列腺切除术后生化复发的风险明显高于PI-RADS 3或4病变患者。此外,与各自的对照组相比,T-Bx检测到任何级别的癌症(P = 0.046)或2级或更高级别癌症(P = 0.005)与PI-RADS 5病变患者的复发风险明显较高有关,但与PI-RADS 3或4病变患者无关:结论:PI-RADS 5 病变可独立预测较差的术后预后。结论:PI-RADS 5 病变可独立预测较差的术后预后。此外,PI-RADS 5 病变的 T-Bx 检查未发现任何级别的癌症或有临床意义的癌症,尤其可预示根治性前列腺切除术的良好预后。
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Prognostic significance of the PI-RADS score in men with prostate cancer undergoing radical prostatectomy.

Objectives: MRI-targeted biopsy (T-Bx) for which Prostate Imaging Reporting and Data System (PI-RADS) assessment categories are useful has been shown to more accurately detect clinically significant prostate cancer. However, the prognostic significance of the PI-RADS in prostate cancer patients needs further investigation. In the present study, we compared radical prostatectomy findings and postoperative oncologic outcomes in men with prostate cancer initially undergoing T-Bx for PI-RADS 3 vs. 4 vs. 5 lesions.

Methods: We assessed consecutive patients undergoing T-Bx with concurrent systematic biopsy (S-Bx), followed by radical prostatectomy. Within our Surgical Pathology database, we identified a total of 207 men where prostatic adenocarcinoma was detected on either S-Bx or T-Bx, or both.

Results: Prostate cancer was detected on S-Bx only (n = 32; 15%), T-Bx only (n = 39; 19%), or both S-Bx and T-Bx (n = 136; 66%). These patients had PI-RADS 3 (n = 42; 20%), 4 (n = 86; 42%), or 5 (n = 79; 38%) lesions, while T-Bx detected cancer in 31 (74%) of PI-RADS 3 cases, 72 (84%) of PI-RADS 4 cases, and 72 (91%) of PI-RADS 5 cases. There were no significant differences in any of the clinicopathologic features examined, including tumor grade on biopsy or prostatectomy and pT or pN stage, among the PI-RADS 3 vs. 4 vs. 5 groups, except a significantly higher rate of positive margin and significantly larger tumor volume in PI-RADS 5 cases than in PI-RADS 3 cases. Univariate and multivariable analyses revealed significantly higher risks of biochemical recurrence after prostatectomy in patients with PI-RADS 5 lesion than in those with PI-RADS 3 or 4 lesion. Additionally, compared with respective controls, detection of any grade cancer (P = 0.046) or Grade Group 2 or higher cancer (P = 0.005) on T-Bx was associated with a significantly higher risk of recurrence in patients with PI-RADS 5 lesion, but not in those with PI-RADS 3 or 4 lesion.

Conclusion: PI-RADS 5 lesions were thus found to independently predict a significantly poorer postoperative prognosis. Moreover, the failure of detection of any grade cancer or clinically significant cancer on T-Bx of PI-RADS 5 lesion may particularly indicate favorable outcomes in radical prostatectomy cases.

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