放射科醫師標註之磁振造影攝護腺腫瘤體積和腫瘤佔比

與接受根除性攝護腺切除手術病人之術前生化指標及術後病理結果 - 關聯性分析

許程皓¹、賴志慶^4,5、黃杞蓉⁶、林志杰^1,2,4、黃逸修^1,2,4、鍾孝仁^1,2,4、黃奕燊^1,2,4、魏子鈞^1,2,4
黃子豪^1,2,4、陳威任^1,2,4、張延驊^1,2、彭昱璟^3,4、鄭浩民^4,6、黃志賢^1,2,4、沈書慧^4,5、林子平^1,2,4

¹臺北榮民總醫院泌尿部; ²國立陽明交通大學書田泌尿科學研究中心; ³臺北榮民總醫院病理檢驗部
⁴國立陽明交通大學醫學院醫學系; ⁵臺北榮民總醫院放射線部; ⁶臺北榮民總醫院教學部

Correlation Between Annotated MRI Tumor Volume and Tumor Percentage with

Pre-operative Biomarkers and Post-operative Pathological Outcomes

among Patients with Prostate Cancer Undergoing

Robot-assisted Laparoscopic Radical Prostatectomy
Chen-Hao Hsu¹, Chih-Ching Lai^4,5, Chi-Jung Huang⁶, Chih-Chieh Lin^1,2,4, Eric Yi-Hsiu Huang^1,2,4,
Hsiao-Jen Chung^1,2,4, I-Shen Huang^1,2,4, Tzu-Chun Wei^1,2,4, Tzu-Hao Huang^1,2,4, Wei-Jen Chen^1,2,4
Yen-Hwa Chang^1,2, Yu-Ching Peng^3,4, Hao-Min Cheng^4,6, William J. Huang^1,2,4, Shu-Huei Shen^4,5, Tzu-Ping Lin^1,2,4

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

² Department of Urology, School of Medicine, College of Medicine and Shu-Tien

Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

³ Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

⁴ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

⁵ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

⁶ Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan

Introduction: 

There is a paucity of literature that highlights the clinical relevance of the radiologists’ annotated MRI tumor volume and tumor percentage of prostate cancer. We aim to understand the associations of the annotated tumor metrics with pre-operative biomarkers, as well as with post-operative pathological outcomes.

Materials and methods:  
A retrospective analysis was conducted on a cohort of 76 patients with prostate cancer, who underwent MRI followed by robot-assisted laparoscopic radical prostatectomy in between 2017 and 2019. MRI data were employed to calculate tumor volume and tumor percentage based on annotations made by an experienced radiologist. The anatomical zones of the prostate and tumor regions were delineated from the T2W axial plane by the radiologist, with the volumes of the prostate and tumor subsequently determined by multiplying the voxel size by the labeled quantity. Pre-operative biomarkers, including PSA, free PSA, PSA density, prostate health index (PHI), and PHI density were retrospectively collected. Aggressive pathological outcomes were defined as pathological T3 or a Gleason score (GS) greater than 6, as determined in the specimens. We investigated the associations between MRI-derived tumor metrics, pre-operative biomarkers, and post-operative aggressive pathological outcomes using correlation analyses and logistic regression models, adjusting for potential confounding factors.

Results:

The mean tumor volume among the 76 patients, as calculated from the radiologist’s annotations on the MRI, was 3.15 ml (SD 5.91; median 1.72 ml, IQR 0.82-3.30), and the mean tumor percentage was 6.69% (SD 8.57; median 4.33, IQR 1.80-7.89). Tumor percentage exhibited the highest Spearman correlation coefficients (r = 0.42, 0.41, and 0.44; all p < 0.05) with PHI density among the three different prostate volume measurement methods utilizing ultrasound and MRI-derived ellipsoid formulation and MRI annotations. PSA, PSA density, and PHI were significantly correlated with tumor percentage (r = 0.29, 0.37, and 0.39, respectively; all p < 0.05). Additionally, tumor volume exhibited significant correlations with PSA and fPSA (r = 0.30 and 0.28, respectively; p < 0.05). Neither tumor volume nor tumor percentage significantly correlated with aggressive pathological outcomes, including pT3 (OR 0.98, 95% CI 0.90 - 1.06; OR 0.99, 95% CI 0.94 - 1.04) and GS > 6 (OR 0.94, 95% CI 0.86 - 1.03; OR 1.00, 95% CI 0.91 - 1.10).

Conclusion: 

PHI density exhibited the strongest correlation with radiologists’ annotated MRI tumor percentage, followed by PSA, PSA density, and PHI. Both tumor volume and percentage showed no significant correlation with post-operative aggressive pathological outcomes.