文章：

磁共振引导下活检中Gleason模式4的量化预测中危前列腺癌患者根治性前列腺切除术中的不良病理结果

Quantification of Gleason Pattern 4 at MRI-Guided Biopsy to Predict Adverse Pathology at Radical Prostatectomy in Intermediate-Risk Prostate Cancer Patients

原文发布日期：17 November 2023

DOI: 10.3390/cancers15225462

类型: Article

开放获取: 是

英文摘要：

Background: Data on Gleason pattern 4 (GP4) amount in biopsy tissue is important for prostate cancer (PC) risk assessment. We aim to investigate which GP4 quantification method predicts adverse pathology (AP) at radical prostatectomy (RP) the best in men diagnosed with intermediate-risk (IR) PC at magnetic resonance imaging (MRI)-guided biopsy. Methods: We retrospectively included 123 patients diagnosed with IR PC (prostate-specific antigen <20 ng/mL, grade group (GG) 2 or 3, no iT3 on MRI) at MRI-guided biopsy, who underwent RP. Twelve GP4 amount-related parameters were developed, based on GP4 quantification method (absolute, relative to core, or cancer length) and site (overall, targeted, systematic biopsy, or worst specimen). Additionally, we calculated PV×GP4 (prostate volume × GP4 relative to core length in overall biopsy), aiming to represent the total GP4 volume in the prostate. The associations of GP4 with AP (GG ≥ 4, ≥pT3a, or pN1) were investigated. Results: AP was reported in 39 (31.7%) of patients. GP4 relative to cancer length was not associated with AP. Of the 12 parameters, the highest ROC AUC value was seen for GP4 relative to core length in overall biopsy (0.65). an even higher AUC value was noted for PV × GP4 (0.67), with a negative predictive value of 82.8% at the optimal threshold. Conclusions: The lack of an association of GP4 relative to cancer length with AP, contrasted with the better performance of other parameters, indicates directions for future research on PC risk stratification to accurately identify patients who may not require immediate treatment. Incorporating formulas aimed at GP4 volume assessment may lead to obtaining models with the best discrimination ability.

摘要翻译： 

背景：活检组织中Gleason模式4（GP4）的数量数据对于前列腺癌（PC）风险评估至关重要。本研究旨在探讨，在磁共振成像（MRI）引导活检诊断为中危（IR）PC的男性中，哪种GP4量化方法能最佳预测根治性前列腺切除术（RP）后的不良病理（AP）结果。方法：我们回顾性纳入了123例在MRI引导活检中诊断为IR PC（前列腺特异性抗原<20 ng/mL，分级分组（GG）为2或3，MRI未见iT3）并接受了RP的患者。基于GP4量化方法（绝对数量、相对于穿刺条长度或癌组织长度）及取样部位（总体、靶向、系统活检或最差标本），我们构建了12个与GP4数量相关的参数。此外，我们计算了PV×GP4（前列腺体积 × 总体活检中相对于穿刺条长度的GP4比例），旨在代表前列腺中GP4的总体积。我们研究了GP4与AP（GG ≥ 4、≥pT3a或pN1）之间的关联。结果：39例（31.7%）患者报告了AP。相对于癌组织长度的GP4与AP无关联。在12个参数中，总体活检中相对于穿刺条长度的GP4获得了最高的ROC曲线下面积（AUC）值（0.65）。PV × GP4的AUC值更高（0.67），在最佳阈值下的阴性预测值为82.8%。结论：相对于癌组织长度的GP4与AP缺乏关联，而其他参数表现更佳，这为未来PC风险分层研究指明了方向，以准确识别可能无需立即治疗的患者。纳入旨在评估GP4体积的公式可能有助于获得具有最佳区分能力的模型。

原文链接：

Quantification of Gleason Pattern 4 at MRI-Guided Biopsy to Predict Adverse Pathology at Radical Prostatectomy in Intermediate-Risk Prostate Cancer Patients