Objectives: This study aimed to assess the impact of the covariates derived from a predictive model for detecting extracapsular extension on pathology (pECE+) on biochemical recurrence-free survival (BCRFS) within 4 years after robotic-assisted radical prostatectomy (RARP). Methods: Retrospective data analysis was conducted from a single center between 2015 and 2022. Variables under consideration included prostate-specific antigen (PSA) levels, patient age, prostate volume, MRI semantic features, and Grade Group (GG). We also assessed the influence of pECE+ and positive surgical margins on BCRFS. To attain these goals, we used the Kaplan–Meier survival function and the multivariable Cox regression model. Additionally, we analyzed the MRI features on BCR (biochemical recurrence) in low/intermediate risk patients. Results: A total of 177 participants with a follow-up exceeding 6 months post-RARP were included. The 1-year, 2-year, and 4-year risks of BCR after radical prostatectomy were 5%, 13%, and 21%, respectively. The non-parametric approach for the survival analysis showed that adverse MRI features such as macroscopic ECE on MRI (mECE+), capsular disruption, high tumor capsular contact length (TCCL), GG ≥ 4, positive surgical margins (PSM), and pECE+ on pathology were risk factors for BCR. In low/intermediate-risk patients (pECE− and GG < 4), the presence of adverse MRI features has been shown to increase the risk of BCR. Conclusions: The study highlights the importance of incorporating predictive MRI features for detecting extracapsular extension pre-surgery in influencing early outcomes and clinical decision making; mECE+, TCCL, capsular disruption, and GG ≥ 4 based on pre-surgical biopsy were independent prognostic factors for early BCR. The presence of adverse features on MRI can assist in identifying low/intermediate-risk patients who will benefit from closer monitoring.
目的：本研究旨在评估用于检测病理学包膜外侵犯的预测模型协变量对机器人辅助根治性前列腺切除术后4年内无生化复发生存率的影响。方法：对2015年至2022年间单中心数据进行回顾性分析。纳入分析的变量包括前列腺特异性抗原水平、患者年龄、前列腺体积、MRI语义特征及分级分组。同时评估了病理学包膜外侵犯阳性与手术切缘阳性对无生化复发生存率的影响。为达成研究目标，采用Kaplan-Meier生存函数及多变量Cox回归模型进行分析，并特别针对中低危患者的MRI特征与生化复发关系进行深入探讨。结果：共纳入177例术后随访超过6个月的参与者。根治性前列腺切除术后1年、2年及4年生化复发风险分别为5%、13%和21%。生存分析的非参数方法显示：MRI宏观包膜外侵犯阳性、包膜中断、高肿瘤包膜接触长度、分级分组≥4级、手术切缘阳性及病理学包膜外侵犯阳性均为生化复发的危险因素。在中低危患者中，不良MRI特征的存在会显著增加生化复发风险。结论：本研究强调术前MRI预测包膜外侵犯的特征对早期预后及临床决策的重要价值；基于术前活检的MRI宏观包膜外侵犯阳性、肿瘤包膜接触长度、包膜中断及分级分组≥4级是早期生化复发的独立预后因素。MRI不良特征有助于识别需要加强监测的中低危患者群体。
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