PI-RADs v2评分≤3分患者前列腺穿刺术后非临床有意义结果的预测因素

Prognostic factors of biopsy-proven clinically insignificant outcomes in patients with PI-RADs v2≤3

目的探讨第2版前列腺影像报告和数据系统(PI-RADs v2)评分≤3分患者前列腺穿刺术后非临床有意义结果的预测因素,并构建临床预测模型。方法回顾性研究,数据选自2012年1月至2018年7月于首都医科大学附属北京友谊医院行前列腺穿刺患者构成的数据库。统计分析其相关临床指标,采用Logistic回归确定穿刺非临床有意义结果的预测因素,并构建基于此因素的模型。ROC曲线用以评估模型及各临床指标预测的诊断效能。结果共491例患者纳入研究。前列腺癌(PCa)的检出率为28. 5%(140/491),临床有意义PCa(CSPCa)的检出率为14. 5%(71/491),临床无意义PCa(CIPCa)的检出率为14. 1%(69/491),良性结果为71. 5%(351/491)。非临床有意义结果(包括临床无意义前列腺癌和良性结果)的检出率为85. 5%(420/491)。多因素分析证实,仅年龄、前列腺特异抗原密度(PSAD)、PI-RADs v2为非临床有意义前列腺癌(non-CSPCa)的预测因素。ROC曲线分析显示,基于以上3个指标构建的模型的曲线下面积(AUC)高于以上3个指标。当以PSAD为0. 20 ng/ml^2作为阈值时,模型预测non-CSPCa的AUC较PSAD阈值为0. 15 ng/ml2时高,而模型预测non-PCa的AUC则以PSAD阈值为0. 15 ng/ml^2时更高。结论年龄、PSAD、PI-RADs v2为non-CSPCa的独立预测因素。基于年龄、PSAD、PI-RADs v2等指标构建的预测模型具有较好的预测能力。

Objective To determine the prognostic factors of biopsy-proven clinically insignificant outcomes in patients with PI-RADs v2≤3 and develop a predictive model based on the variables.Methods The database was constructed of 491 men who received transrectal ultrasound-guided 24-core biopsy as well as pre-biopsy multi-parametric magnetic resonance imaging(mp-MRI)in our institution between January 2012 to July 2018.Logistic regression analysis was used to confirm the predictive factors regarding biopsy-proven clinically insignificant outcomes in modelling.Receiver operating curves were made to assess the sensitivity and specificity of the model as well as the variables.Results Detection rates of prostate cancer and clinically significant prostate cancer were 28.5%(140/491)and 14.5%(71/491).Detection rates of clinically insignificant prostate cancer and benign outcomes were 14.1%(69/491)and 71.5%(351/491).Detection rate of clinically insignificant outcomes(non-CSPCa)was 85.5%(420/491).Multivariate analysis showed that age,PSAD and PI-RADs v2 results were predictive factors of non-CSPCa.ROC analysis showed that the model based on those three variables had a higher AUC than the variables alone.When predicting non-CSPCa,a higher AUC was achieved when the threshold of PSAD was 0.20ng/ml^2 and when predicting non-PCa,a higher AUC was achieved when the threshold of PSAD was 0.15 ng/ml^2.Conclusion Age,PSAD and PI-RADs v2 were independent factors in predicting non-CSPCa.The model based on those variables had a good discrimination when used as a predictive tool.