多参数MRI特征和临床因素与前列腺癌术后生化复发风险的相关性分析

The correlation analysis of multi-parametric MRI features and clinical factors with the risk of biochemical recurrence after radical prostatectomy

    摘要
  • 摘要:
    目的 探究多参数MRI（mpMRI）特征和临床因素与前列腺癌（PCa）根治性切除术后生化复发（BCR）风险的相关性。
    方法 回顾性分析2013年9月至2020年10月于青岛大学附属医院行PCa根治性切除术前行mpMRI检查的152例男性患者的影像学资料及临床资料，年龄44~82（69.0±7.2）岁。根据前列腺影像报告和数据系统（PI-RADS）分析MRI特征，主要包括PI-RADS评分、前列腺体积、肿瘤最大径、肿瘤部位、是否累及包膜或精囊、mpMRI临床T分期。采用最新的PI-RADS V2.1进行mpMRI图像评分。将发生BCR作为随访的终点。应用X-tile统计软件确定连续变量的最佳临界值。采用Log-rank检验和Cox比例风险回归模型对PCa术后BCR的独立危险因素进行单因素和多因素分析。
    结果 中位随访时间13个月，术后BCR发生率为27%（41/152）。单因素分析结果显示，身体质量指数（BMI）、术前前列腺特异性抗原（PSA）水平及前列腺特异性抗原密度（PSAD）水平、穿刺和术后Gleason评分、PI-RADS评分、肿瘤部位、肿瘤最大径、MRI累及包膜、病理包膜侵犯和精囊侵犯、mpMRI临床T分期是PCa术后BCR的危险因素（χ2=4.224~23.531，均P<0.05）。多因素分析结果显示，BMI 、术前PSA水平及MRI累及包膜是PCa术后BCR的独立危险因素（HR=3.238、2.675、3.175，95%CI：1.437~7.293、1.046~6.841、1.061~9.502，均P<0.05）。
    结论 低BMI、术前高PSA水平及MRI累及包膜与PCa根治性切除术后BCR密切相关。

     

    Abstract:
    Objective To investigate the correlation of multi-parametric magnetic resonance imaging (mpMRI) features and clinical factors with the risk of biochemical recurrence (BCR) after radical prostatectomy.
    Methods A retrospective analysis was performed on the imaging data and clinical data of 152 male patients who were aged 44–82 (69.0±7.2) years and underwent mpMRI before radical prostatectomy in the Affiliated Hospital of Qingdao University from September 2013 to October 2020. Magnetic resonance imaging (MRI) features were analyzed according to the Prostate Imaging Report and Data System (PI-RADS), which mainly included PI-RADS score, prostate volume, maximum tumor diameter, tumor site, involvement of capsule and seminal vesicle, and mpMRI clinical T staging. mpMRI images were scored using the latest prostate PI-RADS V2.1. The occurrence of BCR was used as the end point of follow-up. X-tile statistical software was used to determine the optimal critical value of continuous variables. Univariate and multivariate analyses were performed using log-rank test and Cox proportional risk regression model to analyze the independent risk factors of BCR after radical prostatectomy.
    Results The median follow-up was 13 months, and BCR rate was 27% (41/152). The results of univariate analysis showed that body mass index (BMI), preoperative prostate specific antigen (PSA) levels and prostate specific antiqen density (PSAD) levels, biopsy and postoperative pathologica Gleason score, PI-RADS score, tumor site, maximum diameter of tumor lesion, MRI involvement of the capsule, pathological capsule invasion, seminal vesicle invasion, and mpMRI clinical T stage were the risk factors for BCR (χ2=4.224–23.531, all P<0.05). The results of multivariate analysis showed that BMI, preoperative PSA levels, and MRI involvement of the capsule were independent risk factors for BCR after radical prostatectomy (HR=3.238, 2.675, 3.175; 95%CI: 1.437–7.293, 1.046–6.841, 1.061–9.502; all P<0.05).
    Conclusion Low BMI, high PSA level, and MRI involvement of the capsule were closely associated with BCR after radical prostatectomy.

     

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