MRI影像学淋巴结包膜外侵犯对前列腺癌远处转移的预测价值

Predictive value of MRI radiologic extranodal extension for distant metastasis of prostate cancer

目的探讨MRI影像学淋巴结包膜外侵犯(rENE)对前列腺癌(PCa)远处转移的预测价值。方法回顾性分析2017年1月至2022年4月空军军医大学西京医院初诊行MRI和68Ga-前列腺特异性膜抗原(PSMA)PET/CT检查的107例临床诊断N1期PCa患者。根据MRI评估rENE情况,根据68Ga-PSMA PET/CT结果分为有远处转移组(M1组,87例)和无远处转移组(M0组,20例)。采用独立样本t检验、Mann-WhitneyU检验或χ^(2)检验比较组间临床指标和rENE的差异,行多因素logistic回归分析筛选影响远处转移的独立危险因素。采用受试者操作特征(ROC)曲线评价独立危险因素对PCa远处转移的预测效能。结果M1组rENE阳性72例(82.8%)、rENE阴性15例(17.2%),M0组rENE阳性7例(35.0%)、rENE阴性13例(65.0%),组间rENE差异有统计学意义(χ^(2)=19.20,P<0.001)。M1组与M0组间总前列腺特异性抗原水平、国际泌尿病理协会分级、T分期差异均有统计学意义(P<0.05)。多因素logistic回归分析显示rENE(OR=6.248,95%CI 1.807~21.600,P=0.004)是PCa远处转移的独立危险因素,rENE诊断PCa远处转移的ROC曲线下面积为0.739(95%CI 0.607~0.871),灵敏度为82.8%,特异度为65.0%。结论rENE是PCa远处转移的独立预测因素,预测远处转移具有较高的效能,相比于rENE阴性患者,rENE阳性患者的侵袭程度更高,更易出现远处转移病灶。

Objective To investigate the predictive value of MRI radiologic extranodal extension(rENE)for distant metastasis of prostate cancer(PCa).Methods The data of 107 patients of initial visit with clinically diagnosed N1 PCa who underwent MRI and 68Ga-prostate specific membrane antigen(PSMA)PET/CT examinations were retrospectively analyzed at Xijing Hospital,Air Force Medical University from January 2017 to April 2022.The rENE was evaluated with MRI.According to the results of 68Ga-PSMA PET/CT,the patients were divided into the distant metastasis group(group M1,87 cases)and the non-distant metastasis group(group M0,20 cases).Independent sample t test,Mann-Whitney U test orχ^(2) test were used to compare the differences in clinical indicators and rENE between the two groups.The multivariate logistic regression analysis was used to screen the independent risk factors affecting distant metastasis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of independent risk factors for PCa distant metastasis.Results In group M1,72 cases(82.8%)were rENE positive and 15 cases(17.2%)were rENE negative,and in group M0,7 cases(35.0%)were rENE positive and 13 cases(65.0%)were rENE negative,and there was a statistically significant difference in rENE between the two groups(χ^(2)=19.20,P<0.001).There were significant differences in total prostate specific antigen level,International Society of Urological Pathology grade and T stage between the group M1 and the group M0(P<0.05).Multivariate logistic regression analysis showed that rENE(OR=6.248,95%CI 1.807-21.600,P=0.004)was an independent risk factor for distant metastasis of PCa,and the area under the ROC curve of rENE in the diagnosis of distant metastasis of PCa was 0.739(95%CI 0.607-0.871),the sensitivity was 82.8%,and the specificity was 65.0%.Conclusion rENE is an independent predictor of distant metastasis of PCa,which has a high efficacy.Compared with patients with rENE negative,PCa patients with rENE positive have a higher degree of invasion and are more likely to have distant metastasis.