多模态MRI参数联合血清miR-301a水平评估前列腺癌危险程度及预测早期复发的价值

The value of multimodal MRI parameters combined with serum miR-301A levels in differentiating the risk and predicting early recurrence of prostate cancer

目的:探讨多模态MRI参数联合血清miR-301a水平评估前列腺癌危险程度及预测早期复发的价值。方法:选择50例前列腺癌患者作为研究对象,并选择同期50例经病理检查证实为良性前列腺增生的患者作为对照组。受检者均行多模态MRI(T_(1)WI、T_(2)WI、抑脂T_(2)WI、DWI、DCE-MRI序列)检查,记录ADC值、达峰时间(Tmax)、最大强化程度(SImax)及最快强化率(Rmax)。应用定量实时聚合酶链反应法测定血清中miR-301a的相对表达水平。采用国际泌尿病理学会前列腺癌分级标准对前列腺癌患者进行组织病理学评价,分为高危组和中低危组。术后定期对患者进行随访,分为早期复发组和未复发组。结果:前列腺癌组的ADC值、Tmax显著低于良性前列腺增生组,SImax、Rmax和血清miR-301a水平显著高于良性前列腺增生组,差异均有统计学意义(P值均<0.05)。高危组的ADC值显著低于中低危组,而SImax和血清miR-301a水平显著高于中低危组,差异均有统计学意义(P值均<0.05)。ADC值、SImax和血清miR-301a水平鉴别高危与中低危前列腺癌的AUC分别为0.659(95%CI:0.505~0.812,P=0.055)、0.771(95%CI:0.638~0.904,P=0.001)和0.747(95%CI:0.603~0.891,P=0.003);三者联合鉴别高危与中低危前列腺癌的AUC为0.839(95%CI:0.730~0.948,P<0.001),敏感度和特异度分别为77.8%和78.3%。复发组的ADC值显著低于未复发组,而血清miR-301a水平显著高于未复发组,差异有统计学意义(P<0.05)。ADC值、血清miR-301a水平预测早期复发的AUC分别为0.700(95%CI:0.551~0.849,P=0.017)和0.792(95%CI:0.663~0.920,P=0.001),两者联合预测早期复发的AUC为0.813(95%CI:0.689~0.938,P<0.001),敏感度和特异度分别为80.0%和80.0%。结论:多模态MRI参数联合血清miR-301a水平在前列腺癌危险程度评估及早期复发预测中具有一定价值。

Objective:To investigate the value of multimodal MRI parameters combined with serum miR-301A levels in differentiating the risk degree and predicting early recurrence of prostate cancer.Methods:Fifty patients with prostate cancer were selected as the study subjects,and 50 patients with benign prostatic hyperplasia confirmed by pathological examination during the same period were selected as the control group.All subjects received multimodal MRI(T_(1)WI,T_(2)WI,fat suppression T_(2)WI,DWI and DCE-MRI sequences),and ADC value,peak time(Tmax),maximum enhancement degree(SImax)and fastest enhancement rate(Rmax)were recorded.The relative expression level of miR-301A in serum was determined by quantitative real-time polymerase linked reaction.The histopathological evaluation of prostate cancer patients was carried out according to the international Society of Urology Pathology classification standard,and the patients were divided into high-risk group and medium-low risk group.Patients were followed up regularly after surgery and divided into early recurrence group and non-recurrence group.Results:The ADC value and Tmax in prostate cancer group were significantly lower than those in benign prostatic hyperplasia group,and SImax,Rmax and serum miR-301A levels in prostate cancer group were significantly higher than those in benign prostatic hyperplasia group(all P<0.05).ADC value in the high-risk group was significantly lower than that in the medium-low risk group,while SImax and serum miR-301A levels in the high-risk group were significantly higher than those in the medium-low risk group(P<0.05).The AUC of ADC value,SImax and serum miR-301A levels in differentiating high-risk prostate cancer from medium-low risk prostate cancer were 0.659(95%CI:0.505~0.812,P=0.055),0.771(95%CI:0.638~0.904,P=0.001)and 0.747(95%CI:0.603~0.891,P=0.003),respectively.The AUC of the combination of the three indexes in differentiating between high-risk prostate cancer and medium-low risk prostate cancer was 0.839(95%CI:0.730~0.948,P<0.001),with the sensitivity and specificity of 77.8%and 78.3%,respectively.The ADC value in the recurrence group was significantly lower than that in the non-recurrence group,and the serum miR-301A level in recurrence group was significantly higher than that in the non-recurrence group(P<0.05).ADC value and serum miR-301A levels predicted early recurrence with an AUC of 0.700(95%CI:0.551~0.849,P=0.017)and 0.792(95%CI:0.663~0.920,P=0.001),respectively;and the AUC of the combined two indexes in predicting early recurrence was 0.813(95%CI:0.689~0.938,P<0.001),with the sensitivity and specificity of 80.0%and 80.0%,respectively.Conclusion:The combination of multimodal MRI parameters and serum miR-301A level has certain value in risk assessment and early recurrence predication of prostate cancer.