PI-RADS评分与前列腺癌病理结果的相关性分析

Correlation analysis between prostate imaging report and data system score and pathological results of prostate cancer

目的探讨前列腺成像报告和数据系统(PI-RADS)评分与前列腺癌(PCa)国际泌尿病理协会(ISUP)分级之间的相关性以及PI-RADS评分在预测临床有意义PCa(csPCa)、切缘阳性、病理升级等病理特征方面的作用。方法将2013年5月至2019年12月间在苏北人民医院泌尿外科行多参数磁共振(mpMRI)病理为阳性患者纳入研究,根据病理检查方式分为活检组(523例)和根治性前列腺切除术(RP)组(215例),评估两组PI-RADS评分与ISUP分级之间的相关性以及预测csPCa的准确性,对RP组进一步探讨PI-RADS评分与术后病理升级或降级情况和切缘阳性之间的相关性,以及受试者工作特征(ROC)曲线下与坐标轴围成的面积(AUC)。结果活检组和RP组的年龄分别为(72±8)岁和(68±7)岁,前列腺体积分别为48.3(32~57)cm3和47.2(32~54)cm3,前列腺特异抗原(PSA)水平分别为26.3(10.2~34.2)μg/L和21.7(9.24~23.95)μg/L;活检组PI-RADS评分≤3、4、5分别为109例、97例、317例,RP组为61例、55例、99例;活检组和RP组不同PI-RADS评分的ISUP分级组成存在差异,且差异有统计学意义(P均<0.001),两者之间呈正相关(活检组r=0.493,RP组r=0.671,P均<0.001);利用PI-RADS评分预测csPCa,活检组(AUC=0.764,P<0.001,95%CI:0.710~0.819)和RP组(AUC=0.807,P<0.001,95%CI:0.735~0.879)均有一定的准确性,结合PSA,可以提高活检组(AUC=0.795,P<0.001,95%CI:0.746~0.843)和RP组(AUC=0.852,P<0.001,95%CI:0.789~0.915)对csPCa预测的准确性。RP组术后病理结果与穿刺病理结果相比,52.6%的患者出现了ISUP分级的变化,在升级和降级的患者中PI-RADS评分组成差异无统计学意义(P>0.05),但是在活检为ISUP 1级的患者中41.7%(27/65)出现了病理升级,PI-RADS≤3分占33.3%,而PI-RADS>3分占66.7%,两组之间差异有统计学意义(P<0.05)。术后43.3%的患者切缘阳性,PI-RADS评分≤3、4、5分的患者分别为13例(14%)、24例(25.8%)、56例(60.2%),而切缘阴性患者的PI-RADS评分≤3、4、5分分别为48例(39.3%)、31例(25.4%)、43例(35.2%),两者差异有统计学意义(P<0.001),PI-RADS评分越高,切缘阳性可能性越大。结论PI-RADS评分与PCa的ISUP分级存在相关性,联合PSA可较为准确地预测csPCa;同时PI-RADS评分越高,RP后切缘阳性和穿刺时Gleason评分3+3=6分的患者病理升级的可能性越大。

Objective To explore the correlation between prostate imaging report and data system(PI-RADS)score and international society of uological pathology(ISUP)grade of prostate cancer(PCa)and the role of PI-RADS score in predicting the pathological features of clinically significant PCa(csPCa),positive surgical margin and pathological upgrade.Methods The pathologically positive patients with multi-parameter magnetic resonance image(mpMRI)were included in this study.The patients with prostate specific antigen(PSA)<100μg/L were divided into two groups:biopsy group(n=523)and RP group(n=215).The correlation between PI-RADS score and ISUP grade and the accuracy of predicting csPCa in the two groups were evaluated.In the RP group,the correlation between PI-RADS score and postoperative pathological grade or degradation and positive incisal margin was further discussed.The patients with PSA≥100μg/L(171cases in biopsy group and 6 cases in RP group)were not included in the statistical analysis,and the results were simply described.Results The age,prostate volume,and PSA level of biopsy group and RP group was(72±8)years vs(68±7)years,48.3(32-57)cm3 vs 47.2(32-54)cm3,and 26.3(10.2-34.2)μg/L vs 21.7(9.24-23.95)μg/L,respectively.The PI-RADS scores≤3,4,and 5 in the biopsy group were 109,97,and 317 respectively,and those in the RP group were 61,55,and 99 respectively.There were significant differences in the composition of ISUP grades of different PI-RADS scores between the two groups(P<0.001),and there was a positive correlation between the two groups(r=0.493 in the biopsy group,r=0.671 in the RP group,both P<0.001).Using PI-RADS score to predict csPCa,biopsy group(AUC=0.764,P<0.001,95%CI:0.710-0.819)and RP group(AUC=0.807,P<0.001,95%CI:0.735-0.879)had certain accuracy.The PI-RADS score combined with PSA could improve the accuracy of csPCa prediction in the biopsy group(AUC=0.795,P<0.001,95%CI:0.746-0.843)and the RP group(AUC=0.852,P<0.001,95%CI:0.789-0.915).Compared with the pathological results of biopsy in the RP group,52.6%of the patients showed upgrade and degrade of ISUP,and there was insignificant difference in the composition of PI-RADS scores between upgraded and degraded patients(P>0.05).However,41.7%(27/65)of the patients with ISUP grade 1 biopsies had pathological upgrades that the patients with PI-RADS≤3 accounted for 33.3%,while the patients with PI-RADS>3 accounted for 66.7%,and there was significant difference between the two groups(P<0.05).After RP,43.3%of the patients had positive surgical margins,and the patients with PI-RADS score≤3,4 and 5 were 13(14%),24(25.8%)and 56(60.2%),respectively,while the PI-RADS scores of patients with negative surgical margin were 48(39.3%),31(25.4%)and 43(35.2%),respectively.There was significant difference between the two groups(P<0.001).The higher the PI-RADS score,the greater the possibility of the positive surgical margin.For the patients with PSA≥100μg/L,98.8%(169/171)patients in the biopsy group had a PI-RADS score 5.The pathological results of all patients were csPCa,of which 85.4%(146/171)had ISUP grade≥4.Among them,6 cases underwent RP,5 cases had ISUP grade≥4,all surgical margin were positive,5 cases had seminal vesicle invasion,3 cases had capsule invasion and 3 cases had positive pelvic lymph nodes.Conclusion ThePI-RADS score is correlated with the ISUP grade of PCa.Combined with PSA can accurately predict csPCa.At the same time,the higher PI-RADS score,the more likely the patients with positive incisal margin after RP and Gleason score of 3+3=6 at the time of puncture will be upgraded pathologically.