開發結合攝護腺健康指數與多參數磁振造影的模型以預測根除性攝護腺切除標本的攝護腺外侵犯

黃裕賓¹、林子平^1,2、黃子豪^1,2、魏子鈞^1,2、黃奕燊^1,2、范玉華^1,2、林志傑^1,2、黃逸修^1,2
鍾孝仁^1,2、郭俊逸^1,2、吳宏豪^1,2、盧星華^1,2、張延驊^1,2、林登龍^1,2、黃志賢^1,2

台北榮民總醫院 泌尿部¹；國立陽明交通大學醫學院 泌尿學科 書田泌尿科學研究中心²

Development of a nomogram with combined prostate health index and multiparametric magnetic resonance imaging for predicting extracapsular extension in radical prostatectomy specimens

Yu-Pin Huang¹, Tzu-Ping Lin^1,2,*, Tzu-Hao Huang ^1,2, Tzu-Chun Wei^1,2, I-Shen Huang^1,2
Yu-Hua Fan^1,2,Chi-Chieh Lin^1,2, Eric Y.H. Huang^1,2, Hsiao-Jen Chung^1,2, Junne-Yih Kuo^1,2
Howard H.H. Wu^1,2, Shing-Hwa Lu^1,2, Yen-Hwa Chang^1,2, Alex T.L. Lin^1,2, William J.S. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan;

²Department of Urology, School of Medicine, and Shu-Tien Urological Institute,
National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Surgical margin status is an important factor for biochemical recurrence after radical prostatectomy (RP). Pre-operative understanding of the presence of the extraprostatic extension (EPE) is essential to the surgeon to select eligible patients for nerve-sparing procedures to better preserve post-prostatectomy functional outcome. At present, multiparametric magnetic resonance image (mpMRI) is widely used to assess the clinical stage and tumor location before operation. Besides, the prostate health index (PHI) has held promise for better diagnosis and prognostication of prostate cancer. We developed a nomogram that combined PHI and mpMRI to better predict the possibility of EPE in radical prostatectomy specimens.

Materials and Methods:

We prospectively enrolled patients who were diagnosed with prostate cancer and treated with radical prostatectomy (RP) between February 2017 and July 2019. We have analyzed pre-operative blood samples, including PHI (defined as (p2PSA/fPSA) x √tPSA). Furthermore, mpMRI was performed using a 3-T scanner and reported in the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2). The areas under the receiver operating characteristic curve (ROC) were assessed the predictive value of each variable alone and in combination. Based on logistic regression analysis, a nomogram was developed to predict the probability of EPE.

Results:

One hundred and sixty-seven patients were included for analysis. Postoperative Gleason score was equal or more than 7 in 86.9 % of the patients, and the pathological T stage was T3a or more in 58.1%. Overall staging accuracy of mpMRI for EPE was 71.3%, with sensitivity, specificity, positive predictive value, and negative predictive value of 61.5%, 85.7%, 86.4%, and 60%, respectively. The area under the ROC of standard variables, such as PHI, positive core ratio, the maximum percentage of biopsy tumor, mpMRI were 0.731, 0.773, 0.763, 0.743, respectively. When these four features were combined, AUC reached 0.847.

Conclusions:

A Combination of PHI and mpMRI may further aid in predicting the pathological EPE before the operation. The developed nomogram may be useful in preoperative counseling and may help in decision making in nerve-sparing strategies at radical prostatectomy.