{"title":"核磁共振成像的局部扩展结果弥补了病理分期预测肿瘤结果的能力","authors":"Takahito Wakamiya, Yasuo Kohjimoto, Shimpei Yamashita, Isao Hara","doi":"10.1007/s10147-024-02621-0","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Median age was 69 years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, <i>p</i> = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, <i>p</i> = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, <i>p</i> = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, <i>p</i> = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1–3.9, <i>p</i> = 0.01).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Local extension on MRI is a prognostic factor independent of pathological stage. The use of MRI may complement the prognostic value of excisional pathology of prostate cancer.</p>","PeriodicalId":13869,"journal":{"name":"International Journal of Clinical Oncology","volume":"15 1","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Local extension findings on MRI compensate for the ability of pathological staging to predict oncological outcome\",\"authors\":\"Takahito Wakamiya, Yasuo Kohjimoto, Shimpei Yamashita, Isao Hara\",\"doi\":\"10.1007/s10147-024-02621-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Median age was 69 years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, <i>p</i> = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, <i>p</i> = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, <i>p</i> = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, <i>p</i> = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1–3.9, <i>p</i> = 0.01).</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>Local extension on MRI is a prognostic factor independent of pathological stage. 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引用次数: 0
摘要
背景我们研究了术前核磁共振成像和切除病理结果是否与机器人辅助前列腺癌根治术后的手术切缘阳性和生化复发有关。方法我们对2012年至2020年间接受机器人辅助前列腺癌根治术的704例患者进行了鉴定,并提取了326例术前进行了核磁共振成像扫描并由放射科医生读片的患者。根据核磁共振成像和病理学检查结果,将这些患者分为以下几组:≤ cT2pT2(195 例)、≤ cT2pT3(55 例)、cT3pT2(31 例)和 cT3pT3(45 例)。我们对他们的手术切缘阳性率和生化复发率进行了比较。结果 平均年龄为 69 岁,手术切缘阳性率为 20.2%,五年生化复发率为 20.3%。在切除病理检查未发现局部侵犯的 226 例患者中,MRI 检查有局部扩展(cT3pT2)的患者的手术切缘阳性率(29.0% vs. 14.4%,P = 0.05)和五年生化复发率(25.8% vs. 9.3%,P = 0.01)相对高于MRI检查无局部扩展(≤ cT2pT2)的患者。同样,在切除病理有局部扩展的100例患者中,cT3pT3患者的手术切缘阳性率(37.8% vs. 21.8%,p = 0.08)和五年生化复发率(53.3% vs. 29.3%,p = 0.01)也相对高于≤cT2pT3患者。在多变量分析中,MRI 上的局部扩展是生化复发的独立预测因素(OR 2.1,95%CI 1.1-3.9,p = 0.01)。MRI的使用可补充前列腺癌切除病理的预后价值。
Local extension findings on MRI compensate for the ability of pathological staging to predict oncological outcome
Background
We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy.
Methods
We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them.
Results
Median age was 69 years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, p = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, p = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, p = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, p = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1–3.9, p = 0.01).
Conclusions
Local extension on MRI is a prognostic factor independent of pathological stage. The use of MRI may complement the prognostic value of excisional pathology of prostate cancer.
期刊介绍:
The International Journal of Clinical Oncology (IJCO) welcomes original research papers on all aspects of clinical oncology that report the results of novel and timely investigations. Reports on clinical trials are encouraged. Experimental studies will also be accepted if they have obvious relevance to clinical oncology. Membership in the Japan Society of Clinical Oncology is not a prerequisite for submission to the journal. Papers are received on the understanding that: their contents have not been published in whole or in part elsewhere; that they are subject to peer review by at least two referees and the Editors, and to editorial revision of the language and contents; and that the Editors are responsible for their acceptance, rejection, and order of publication.