摘要
目的 探讨多参数磁共振成像(multiparametric magnetic resonance imaging,mpMRI)阴性前列腺癌患者的临床病理特征,比较其与mpMRI阳性患者在围手术期参数及肿瘤预后方面的差异,为临床决策提供依据。方法 回顾性分析2020年1月至2024年12月苏州大学附属第一医院和苏州大学附属第四医院的442例行腹腔镜下根治性前列腺切除术(laparoscopic radical prostatectomy,LRP)患者的临床资料,根据前列腺影像报告和数据系统(Prostate Imaging Reporting and Data System,PI-RADS) 2.0分为磁共振阴性组(negative MRI,nMRI)(n=62)和磁共振阳性组(positive MRI,pMRI)(n=380),比较两组年龄、直肠指检结果、前列腺特异性抗原(prostate specific antigen,PSA)水平、穿刺阳性针数、术前穿刺病理分级,以及术后病理分期、升级情况等指标。结果 nMRI组较pMRI组具有更低中位年龄(68岁比70岁)、直肠指检阳性率(21.0%比39.2%)、中位总前列腺特异性抗原(total prostate-specific antigen,tPSA)水平(12.0 ng/ml比12.6ng/ml)、中位穿刺阳性针数(2针比3针)及穿刺标本的国际泌尿病理学会(International Society of Urological Pathology,ISUP)前列腺癌预后分级,差异均有统计学意义(P<0.05)。71.0%的nMRI患者被确诊为有临床意义前列腺癌(clinically significant prostate cancer,csPCa),16.1%术后诊断为pT3期,且病理升级率显著高于pMRI组(41.9%比25.3%,P=0.008)。两组在体质量指数、家族史、前列腺体积、切缘阳性率及精囊侵犯率方面比较,差异无统计学意义(P>0.05)。结论 mpMRI阴性患者表现为相对惰性的肿瘤生物学特性,但具有不容忽视的恶性潜能,mpMRI阴性不能完全替代活检。
Objective To investigate the clinicopathological characteristics of prostate cancer patients with negative multiparametric magnetic resonance imaging(mpMRI)and compare their perioperative parameters and tumor prognosis withthose of mpMRI-positive patients,aiming to provide evidence for clinical decisionmaking.Methods Clinical data from 442 patients who underwent laparoscopic radical prostatectomy(LRP)from January 2020 to December 2024 were retrospectively analyzed.Based on PI-RADS v2 scores,patients were divided into negative mpMRI(nMRI,n=62)and positive mpMRI(pMRI,n=380)groups.Comparisons included age,digital rectal examination(DRE)results,PSA levels,number of positive biopsy cores,preoperative pathological grading,postoperative pathological staging,and upgrading rates.Results The nMRI group had significantly lower median age(68 vs.70 years),DRE positivity(21.0%rs.39.2%),median total prostate-specific antigen(tPSA)(12.0 zs.12.6 ng/ml),median positive biopsy cores(2 vs.3),and preoperative International Society of Urological Pathology(ISUP)grading(P<0.05).Among nMRI patients,71.0%were diagnosed with clinically significant prostate cancer(csPCa),16.1%had pT3 disease,and pathological upgrading was significantly higher than that in the pMRI group(41.9%vs.25.3%,P=O.008).No significant differences were observed in BMI,family history,prostate volume,positive surgical margins,or seminal vesicle invasion.Conclusion 1mpMRI-negative patients exhibit relatively indolent tumor biology but still harbor non-negligible malignant potential.mpMRI negativity cannot completely replace biopsy in clinical practice.
作者
张浩洋
缪志俊
沈浩
孙嘉乐
莫浩杰
杨佳健
李鹏
Zhang Haoyang;Miao Zhijun;Shen Hao;Sun Jiale;Mo Haojie;Yang Jiajian;Li Peng(Department of Urology,The Fourth Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215123,China)
出处
《泌尿外科杂志(电子版)》
2025年第4期38-42,共5页
Journal of Urology for Clinicians(Electronic Version)
基金
2024年度苏州自贸区生物医药创新发展项目(SZM2024026)
苏州工业园区临床医学专家团队引进项目(0202140004)
关键词
前列腺癌
磁共振成像
病理诊断
Prostate cancer
Magnetic resonance imaging
Pathologic diagnosis
