PI-RADS评分与1～2针穿刺阳性前列腺癌患者高危病理的相关性研究

Correlation between PI-RADS score and high-risk pathological results of the prostate cancer with 1-2 needles biopsy

目的:分析前列腺穿刺阳性针数为1～2针的前列腺癌患者行根治手术后前列腺标本的病理结果,评估前列腺影像报告和数据系统(PIRADS)评分与根治术后高危病理结果的相关性。方法:回顾2007-2017年北京医院接受MRI检查后前列腺穿刺阳性针数1～2针且接受根治手术的的前列腺癌患者的临床资料,分析患者标本的病理危险度,评估PI-RADS评分与根治术后高危病理结果,Gleason评分改变或分期改变的相关性。进一步分析该组患者中术前评估为低危的患者病理结果出现高危的比例并讨论PI-RADS与其相关性。结果:99例患者中,根治术后高危病理类型患者49例(49.5%)。其中病理分期在T2c及以上的患者共39例(39.4%),根治术后标本Gleason评分≥8分的患者11例(11.1%),切缘阳性患者17例(17.2%)。进一步分析显示在所有患者中含低危患者46例,其中16例(34.8%)患者根治术后出现高危病理类型,PI-RADS评分是该类患者出现根治术后高危病理类型的独立危险因素(P=0.014,OR=3.092,95%CI=1.257～7.606)。99例患者中,有65例(65.7%)患者术后Gleason评分或分期较术前升高,PI-RADS(P=0.043)评分可作为其独立危险因素。结论:穿刺阳性针数为1～2针的前列腺癌患者,根治手术术后病理有一定程度的Gleason评分上升或分期上升,且危险程度在一定程度上被低估,术前PIRADS评分可以作为患者术后出现高危病理类型和分期升高的独立危险因素。

Objective:To analyze the pathological results of prostate specimens in patients with prostate cancer accepting the MRI,who had surgery with 1-2 needles of positive prostate biopsy,and to evaluate the correlation between PI-RADS score and pathological results.Methods:A retrospective analysis was done on prostate cancer patients from 2007 to 2017 in Beijing Hospital who had 1-2 positive biopsy needles after MRI and accepted the radical prostatectomy.The pathological risk of specimens was analyzed,and PI-RADS score and the pathological results,include high-risk pathological factors and upgrade/upstage of the radical surgery specimens,were evaluated.The proportion of patients who were preoperatively assessed as low risk and finally had the high-risk pathological results after radical surgery was further analyzed.The correlation between PI-RADS score and the pathological results was also analyzed.Results:Among the 99 patients,49(49.5%)were of high-risk pathological types after radical prostatectomy.There were 39(39.4%)patients who had pathological staging in T2 c and more,11(11.1%)patients obtained Gleason score over 8 and 17(17.2%)patients had the positive margin.Among all patients,there were 46 patients with low-risk pathological results,among whom 16(34.8%)patients had postoperative high-risk pathological types.PIRADS score was an independent risk factor for patients with low-risk pathological results who had postoperative high-risk pathological types(P=0.014,OR=3.092,95%CI=1.257-7.606).Among the 99 patients,65(65.7%)had upgrade or/and upstage after radical surgery,and pi-rads(P=0.043)score could be used as an independent risk factor.Conclusion:For the prostate cancer patients with 1-2 needles positive needles biopsy after radical prostatectomy,there is a certain upgrade or upstage in pathology and underestimate of the high risk.Preoperative MRI PIRADS score can be used as an independent risk factor for patients with postoperative high-risk pathological types and increased grade or stage.