前列腺癌根治术后Gleason评分升级与术前多参数MRI PI-RADS评分的关系

Relationship between properative MRI PI-RADS score and Gleason score upgrading after radical prostatectomy

目的 探讨前列腺癌根治术后Gleason评分升级与术前多参数MRI（mpMRI）前列腺影像报告数据系统（PIRADS）评分的关系。方法 回顾性分析198例前列腺癌根治术后患者的资料。根据PI-RADS评分分为低分（1~2分）,中分（3分）,高分（≥4分）3组。通过单因素和多因素Logistic回归分析探讨PI-RADS评分与Gleason评分的关系。结果 单因素分析显示,前列腺特异性抗原密度、前列腺体积、术前穿刺病理Gleason评分、精囊侵犯、穿刺阳性针数、PI-RADS评分是术后Gleason评分升级的影响因子（P均〈0.05）。多因素分析显示,前列腺体积（P〈0.01）与术前PI-RADS评分（P〈0.01）是前列腺癌根治术后Gleason评分升级的独立预测因素。术前PI-RADS评分低分组及中分组术前与术后Gleason评分差异无统计学意义（P均〉0.05）;而高分组术后Gleason评分高于术前,差异有统计学意义（P〈0.05）。结论 术前Gleason评分较低（≤6分）而PI-RADS评分较高（≥4分）的小体积前列腺癌患者,术后Gleason评分升级的可能大。

Objective To investigate the relationship between Gleason score upgrading after radical prostatectomy and preoperative prostate imaging reporting and data system （PI-RADS） score of multi-parameter MRI （mpMRI）. Methods Data of 198 patients treated by radical prostatectomy were retrospectively analyzed. According to PI-RADS score, the patients were divided into 3 groups：Low score group （1-2 points）, moderate score group （3 points） and high score group （≥4 points）. Univariate and multivariate Logistic regression analyses were done to investigate the relationship between PI-RADS score and Gleason score. Results Univariate analysis showed that prostate-specific antigen density, prostate volume, preoperative biopsy Gleason score, seminal vesicle invasion, number of positive biopsy needle and PI-RADS score were the influencing factors of postoperative Gleason score upgrading （all P〈0.05）. Multivariate analysis indicated that prostate volume （P〈0.01） and preoperative PI-RADS score （P〈0.01） were independent predictors of Gleason score upgrading after radical prostatectomy. There was no significant difference between preoperative and postoperative Gleason scores in the low and middle PI-RADS score groups （P〉0.05）. The postoperative Gleason score was significantly higher than preoperative Gleason score in high PI-RADS score group （P〈0.05）. Conclusion Lower biopsy Gleason score （≤6 points）, higher PI-RADS score （≥4 points）, smaller prostate volumes are predictors of Gleason score upgrading after radical prostatectomy.