PI-RADS评分3分患者诊断有临床意义前列腺癌的预测因素分析

Study on influencing factors of clinically significant prostate cancer in PI-RADS 3 patients

目的探索前列腺影像报告和数据系统(PI-RADS)评分为3分的患者诊断有临床意义前列腺癌(CsPCa)的预测因素。方法回顾性分析2019年1月至2020年12月南京医科大学第一附属医院133例PI-RADS评分3分行前列腺穿刺患者的临床资料。年龄66(60~72)岁,前列腺特异性抗原(PSA)8.22(5.95~11.41)ng/ml。所有患者均行前列腺4针经会阴靶向穿刺和12针系统穿刺。根据穿刺结果,分为CsPCa组和非CsPCa组。比较两组mpMRI病灶分区位置、偏侧性、局限性及mpMRI各序列参数的差异,并通过多变量二元logistic回归分析PI-RADS评分3分患者为CsPCa的独立预测因素。结果穿刺结果显示非前列腺癌76例,前列腺癌57例(46.62%),其中CsPCa 41例(30.83%)。CsPCa组与非CsPCa组年龄[66(58~70)岁与66(60~72)岁]、体质指数[24.22(21.82~25.71)kg/m^(2)与23.71(21.99~26.12)kg/m^(2)]、PSA[9.39(6.35~12.55)ng/ml与7.67(5.83~10.51)ng/ml]、直肠指检异常率[21.95%(9/41)与9.78%(9/92)]的差异均无统计学意义(P>0.05),PSA密度(PSAD)[0.40(0.16~0.65)ng/ml^(2)与0.17(0.12~0.24)ng/ml^(2)]的差异有统计学意义(P<0.05)。PI-RADS评分3分病灶主要位于移行带[46.62%(62/133)]。CsPCa组MRI病灶位于外周带16例,移行带19例,两区均有6例;右侧16例,左侧15例,双侧10例;病灶弥散19例,局限22例。非CsPCa组病灶位于外周带41例,移行带43例,两区均有8例;右侧26例,左侧35例,双侧31例;病灶弥散56例,局限36例。两组病灶分区位置、侧别、弥散程度差异均无统计学意义(P>0.05)。CsPCa组较非CsPCa组所有MRI序列结果阳性率更高[82.93%(34/41)与40.22%(37/92),P<0.001],T2加权像成像(T2WI)阳性率更高[92.68%(38/41)与75.00%(69/92),P=0.018],弥散加权成像(DWI)阳性率更高[90.24%(37/41)与56.52%(52/92),P<0.001],最大径更大[0.67(0.30~1.19)mm与0.48(0.20~0.62)mm,P<0.001],弥散受限[表观弥散系数(ADC):0.70(0.61~0.87)与1.10(0.86~1.50),P<0.001]。多因素回归分析结果显示,PSAD[5.20(95%CI 1.89~16.90),P=0.012]和病灶ADC[0.58(95%CI 0.40~0.85),P=0.006]是诊断CsPCa的独立预测因子。log2PSAD和ADC受试者工作特征曲线的曲线下面积(AUC)分别为0.72(95%CI 0.61~85.4)和0.71(95%CI 0.55~0.88),log2PSAD-ADC组合平均10折交叉验证AUC=0.78(95%CI 0.65~0.88)。结论PI-RADS评分3分患者的大多数病灶位于移行区,且CsPCa病灶的MRI表现更加明显且弥散受限。PSAD和ADC值是PI-RADS评分3分患者诊断CsPCa的独立预测因素,且log2PSAD-ADC预测模型有助于从PI-RADS评分3分患者中检出CsPCa。

Objective To explore the influencing factors of clinically significant prostate cancer(CsPCa)in patients with PI-RADS score 3.Methods The data of 133 consecutive patients with the PI-RADS score 3 from January 2019 to December 2020 were retrospectively analyzed.All patients underwent 4-needle transperineal targeted biopsy and 12-needle systematic prostate biopsy(SB).The overall age was 66(60-72)years,and the overall PSA value was 8.22(5.95-11.41)ng/ml.All patients underwent multiparametric magnetic resonance imaging(mpMRI),and PI-RADS v2.0 score was 3.Patients were divided into two mutually exclusive groups:non CsPCa group and CsPCa group.The differences of lesion location,laterality,focality and sequence parameters of mpMRI between the two groups were compared,and multivariate binary logistic regression was used to analyze the independent predictors of PI-RADS score 3 in patients with CsPCa.Results Biopsy results showed 57 cases of prostate cancer,including 41 cases of CsPCa,and 76 cases of non-prostate cancer.The detection rate of prostate cancer was 46.62%(57/133),and the detection rate of CsPCa was 30.83%(41/133).There were 41 cases in CsPCa group and 92 cases in non CsPCa group.There was no significant difference between CsPCa group and non CsPCa group in age[66(58-70)years vs.66(60-72)years],body mass index[24.22(21.82-25.71)kg/m^(2)vs.23.71(21.99-26.12)kg/m^(2)],PSA[9.39(6.35-12.55)ng/ml vs.7.67(5.83-10.51)ng/ml],abnormal rate of rectal digital examination[21.95%(9/41)vs.9.78%(9/92)](all P>0.05).There was significant difference in PSAD[0.40(0.16-0.65)ng/ml^(2)vs.0.17(0.12-0.24)ng/ml^(2)](P<0.05).In MRI,PI-RADS=3 lesions were mainly located in the transitional zone[46.62%(62/133)].In CsPCa group,MRI lesions were located in peripheral zone in 16 cases,transitional zone in 19 cases,and both areas in 6 cases.There were 16 cases on the right,15 cases on the left and 10 cases on both sides.The lesions were diffused in 19 cases and localized in 22 cases.In the non CsPCa group,41 lesions were located in the peripheral zone,43 in the transitional zone,and 8 in both areas.There were 26 cases on the right,35 cases on the left and 31 cases on both sides.The lesions were diffuse in 56 cases and localized in 36 cases.There was no significant difference in lesion location,side and diffusion degree between the two groups(P>0.05).Compared with the non CsPCa group,the positive rate of all MRI sequences in CsPCa group was higher(82.93%vs.40.22%,P<0.001),the positive rate of T2 weighted imaging(T2WI)was higher(92.68%vs.75.00%,P=0.018),the positive rate of diffusion weighted imaging(DWI)was higher(90.24%vs.56.52%,P<0.001),the maximum diameter was larger[(0.67(0.30-1.19)mm vs.0.48(0.20-0.62)mm,P<0.001],and the apparent diffusion coefficient(ADC)was lower[0.70(0.61-0.87)vs.1.10(0.86-1.50),P<0.001].Concurrently,PSAD and lesion ADC were important predictors of CsPCa in logistic regression model[mean 10 fold cross validation AUC:0.78(95%CI 0.65-0.88)].Conclusions Most of the MRI lesions in patients with PI-RADS 3 were located in the transitional zone,and the MRI lesions in CsPCa were more obvious and diffusion limited.PSAD and ADC values are independent predictors for the diagnosis of CsPCa in patients with PI-RADS score 3,and the log2PSAD-ADC prediction model is helpful to find CsPCa from patients with PI-RADS score 3 and protect patients from unnecessary biopsy.