Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy
Background: The risk of prostate cancer metastatic is correlated with its volume and grade. These parameters are now best estimated preoperatively with magnetic resonance imaging (MRI) and MRI-guided biopsy. Objective: To estimate the risk of metastatic recurrence after radical prostatectomy (RP) in...
| Những tác giả chính: | , , , , , , , |
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| Định dạng: | Bài viết |
| Ngôn ngữ: | English |
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Elsevier
2022-07-01
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| Loạt: | European Urology Open Science |
| Những chủ đề: | |
| Truy cập trực tuyến: | http://www.sciencedirect.com/science/article/pii/S2666168322005869 |
| _version_ | 1829113307423834112 |
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| author | Thomas Bommelaere Arnauld Villers Philippe Puech Guillaume Ploussard Julien Labreuche Elodie Drumez Xavier Leroy Jonathan Olivier |
| author_facet | Thomas Bommelaere Arnauld Villers Philippe Puech Guillaume Ploussard Julien Labreuche Elodie Drumez Xavier Leroy Jonathan Olivier |
| author_sort | Thomas Bommelaere |
| collection | DOAJ |
| description | Background: The risk of prostate cancer metastatic is correlated with its volume and grade. These parameters are now best estimated preoperatively with magnetic resonance imaging (MRI) and MRI-guided biopsy. Objective: To estimate the risk of metastatic recurrence after radical prostatectomy (RP) in our model versus conventional clinical European Association of Urology (EAU) classification. The secondary objective is biochemical recurrence (BCR). Design, setting, and participants: A retrospective study was conducted of a cohort of 713 patients having undergone MRI-guided biopsies and RP between 2009 and 2018. The preoperative variables included prostate-specific antigen, cT stage, tumor volume (TV) based on the lesion’s largest diameter at MRI, percentage of Gleason pattern 4/5 (%GP4/5) at MRI-guided biopsy, and volume of GP4/5 (VolGP4/5) calculated as TV × %GP4/5. Outcome measurements and statistical analysis: The variables’ ability to predict recurrence was determined in univariable and multivariable Fine-and-Gray models, according to the Akaike information criterion (AIC) and Harrell’s C-index. Results and limitations: Overall, 176 (25%), 430 (60%), and 107 (15%) patients had low, intermediate, and high-risk disease, respectively, according to the EAU classification. During a median follow-up period of 57 mo, metastatic recurrence was observed in 48 patients with a 5-yr probability of 5.6% (95% confidence interval [CI] 3.9–7.7). VolGP4/5 (categories: <0.5, 0.5–1.0, 1.01–3.2, and >3.2 ml) was the parameter with the lowest AIC and the highest C-index for metastatic recurrence of 0.82 (95% CI 0.76–0.88), and for BCR it was 0.73 (95% CI 0.68–0.78). In a multivariable model that included %GP4/5 and TV, C-index values were 0.86 (95% CI 0.79–0.91) for metastatic recurrence and 0.77 (0.72–0.82) for BCR. The same results for EAU classification were 0.74 (0.67–0.80) and 0.67 (0.63–0.72), respectively. Limitations are related to short follow-up and expertise of radiologists and urologists. Conclusions: We developed a preoperative risk tool integrating the VolGP4/5 based on MRI and MRI-guided biopsies to predict metastatic recurrence after RP. Our model showed higher accuracy than conventional clinical risk models. These findings might enable physicians to provide more personalized patient care. Patient summary: Aggressiveness of prostate cancer evaluated before treatment by incorporating magnetic resonance imaging (MRI) and MRI-guided biopsy results gives a better estimate of the risk of metastatic recurrence than previous parameters not based on MRI. |
| first_indexed | 2024-12-12T15:33:34Z |
| format | Article |
| id | doaj.art-bf1a3f47b6484ec184ece2b007f4c38c |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-12-12T15:33:34Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-bf1a3f47b6484ec184ece2b007f4c38c2022-12-22T00:20:03ZengElsevierEuropean Urology Open Science2666-16832022-07-01412434Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted BiopsyThomas Bommelaere0Arnauld Villers1Philippe Puech2Guillaume Ploussard3Julien Labreuche4Elodie Drumez5Xavier Leroy6Jonathan Olivier7Department of Urology, University of Lille, Lille, FranceDepartment of Urology, University of Lille, Lille, France; UMR8161/CNRS-Institut de Biologie de Lille, Lille, FranceDepartment of Radiology, University of Lille, 59000 Lille, FranceDepartment of Urology, La Croix du Sud Hospital, Quint Fonsegrives, FranceDepartment of Biostatistics, CHU Lille, Lille, France; ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, CHU Lille, University of Lille, Lille, FranceDepartment of Biostatistics, CHU Lille, Lille, France; ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, CHU Lille, University of Lille, Lille, FranceDepartment of Histopathology, University of Lille, Lille, FranceDepartment of Urology, University of Lille, Lille, France; UMR8161/CNRS-Institut de Biologie de Lille, Lille, France; Corresponding author. Department of Urology, Hôpital Huriez, Lille University, F-59000 Lille, France. Tel. + 33 320 444 235.Background: The risk of prostate cancer metastatic is correlated with its volume and grade. These parameters are now best estimated preoperatively with magnetic resonance imaging (MRI) and MRI-guided biopsy. Objective: To estimate the risk of metastatic recurrence after radical prostatectomy (RP) in our model versus conventional clinical European Association of Urology (EAU) classification. The secondary objective is biochemical recurrence (BCR). Design, setting, and participants: A retrospective study was conducted of a cohort of 713 patients having undergone MRI-guided biopsies and RP between 2009 and 2018. The preoperative variables included prostate-specific antigen, cT stage, tumor volume (TV) based on the lesion’s largest diameter at MRI, percentage of Gleason pattern 4/5 (%GP4/5) at MRI-guided biopsy, and volume of GP4/5 (VolGP4/5) calculated as TV × %GP4/5. Outcome measurements and statistical analysis: The variables’ ability to predict recurrence was determined in univariable and multivariable Fine-and-Gray models, according to the Akaike information criterion (AIC) and Harrell’s C-index. Results and limitations: Overall, 176 (25%), 430 (60%), and 107 (15%) patients had low, intermediate, and high-risk disease, respectively, according to the EAU classification. During a median follow-up period of 57 mo, metastatic recurrence was observed in 48 patients with a 5-yr probability of 5.6% (95% confidence interval [CI] 3.9–7.7). VolGP4/5 (categories: <0.5, 0.5–1.0, 1.01–3.2, and >3.2 ml) was the parameter with the lowest AIC and the highest C-index for metastatic recurrence of 0.82 (95% CI 0.76–0.88), and for BCR it was 0.73 (95% CI 0.68–0.78). In a multivariable model that included %GP4/5 and TV, C-index values were 0.86 (95% CI 0.79–0.91) for metastatic recurrence and 0.77 (0.72–0.82) for BCR. The same results for EAU classification were 0.74 (0.67–0.80) and 0.67 (0.63–0.72), respectively. Limitations are related to short follow-up and expertise of radiologists and urologists. Conclusions: We developed a preoperative risk tool integrating the VolGP4/5 based on MRI and MRI-guided biopsies to predict metastatic recurrence after RP. Our model showed higher accuracy than conventional clinical risk models. These findings might enable physicians to provide more personalized patient care. Patient summary: Aggressiveness of prostate cancer evaluated before treatment by incorporating magnetic resonance imaging (MRI) and MRI-guided biopsy results gives a better estimate of the risk of metastatic recurrence than previous parameters not based on MRI.http://www.sciencedirect.com/science/article/pii/S2666168322005869Prostate cancerRecurrence riskTumor volumeGleason pattern 4/5 |
| spellingShingle | Thomas Bommelaere Arnauld Villers Philippe Puech Guillaume Ploussard Julien Labreuche Elodie Drumez Xavier Leroy Jonathan Olivier Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy European Urology Open Science Prostate cancer Recurrence risk Tumor volume Gleason pattern 4/5 |
| title | Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy |
| title_full | Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy |
| title_fullStr | Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy |
| title_full_unstemmed | Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy |
| title_short | Risk Estimation of Metastatic Recurrence After Prostatectomy: A Model Using Preoperative Magnetic Resonance Imaging and Targeted Biopsy |
| title_sort | risk estimation of metastatic recurrence after prostatectomy a model using preoperative magnetic resonance imaging and targeted biopsy |
| topic | Prostate cancer Recurrence risk Tumor volume Gleason pattern 4/5 |
| url | http://www.sciencedirect.com/science/article/pii/S2666168322005869 |
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