Risk Factors for pT3a Prostate Cancer in the Patients With cT1-2 on Preoperative Multiparametric Magnetic Resonance Imaging
김경환, 구자윤, 박원영, 홍승백, 김석, 하홍구,
소속 상세정보
김경환 ( Kim Kyung-Hwan )
Pusan National University School of Medicine Pusan National University Hospital Department of Urology
구자윤 ( Ku Ja-Yoon )
Pusan National University School of Medicine Pusan National University Hospital Department of Urology
박원영 ( Park Won-Young )
Pusan National University School of Medicine Pusan National University Hospital Department of Pathology
홍승백 ( Hong Seung-Baek )
Pusan National University School of Medicine Pusan National University Hospital Department of Radiology
김석 ( Kim Suk )
Pusan National University School of Medicine Pusan National University Hospital Department of Radiology
하홍구 ( Ha Hong-Koo )
Pusan National University School of Medicine Pusan National University Hospital Department of Urology
Abstract
Purpose: Our study aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI) to assess the capsular extension of prostate cancer. Risk factors for extraprostatic invasion or microscopic invasion of bladder neck (pT3a stage) in the cases showing localized disease findings on MRI scan were also identified.
Materials and Methods: We identified 198 patients who underwent robot-assisted or conventional laparoscopic radical prostatectomy in our institute between June, 2016 and May, 2018. Altogether, 170 patients with preoperational mpMRI scans and complete pathologic data were included. Positive and negative predictive values of mpMRI to detect capsular extension were estimated. Chi-square test was performed for ratio variables. Logistic regression analysis was performed to identify capsular invasion risk factors.
Results: Median age and prostate-specific antigen level were 68 years and 7.5 ng/mL, respectively. Based on findings, 16 patients (9.4%) were identified as cT3a stage (unilateral or bilateral extraprostatic extension), whereas 37 patients (21.8%) as pT3a stage. Positive and negative predictive values of mpMRI to detect capsular extension were 75.0% and 73.9%, respectively. In the logistic regression analysis, positive biopsy core rate was the significant predictor for pT3a disease in the patients with negative capsular invasion findings on mpMRI (p<0.001). According to receiver-operating characteristic curve (area under the curve=0.691, p=0.001), the positive biopsy core rate of 0.275 was the best threshold.
Conclusions: Multiparametric MRI is an appropriate test to predict pT3a disease preoperatively. The patients with positive core rate over 0.275 may have pT3a diseases despite negative image findings.
키워드
Biopsy; Magnetic resonance imaging; Prostatectomy; Tumor grading; Ultrasonography
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