前列腺癌根治术前 MRI 结果对术后生化复发的预测价值研究

摘要： 目的 研究前列腺癌根治术（RP）前行磁共振成像（MRI）预测术后生化复发的价值。方法 选取 2006— 2013 年 115 例行 RP 且未接受辅助放化疗的前列腺癌患者， 根据其影像资料将其分为 MRI 阳性组 87 例， MRI 阴性组 28 例， 比较 2 组的术前临床资料。以术后前列腺特异性抗原（PSA）数值连续 2 次上升超过 0.2 μg/L 定义为生化复发 （38 例）， 应用 Cox 比例风险回归筛选与生化复发相关的危险因素。结果 MRI 阳性组生存时间短于 MRI 阴性组， 术前 PSA 水平高于阴性组 （P < 0.05）， 2 组年龄差异无统计学意义。MRI 阳性组术前 PSA＞20 μg/L 者的比例、 临床分期为 T3 期的比例、 病理 Gleason 评分≥8 的比例、 存在精囊侵犯 （SVI） 者的比例及内分泌治疗的比例均高于 MRI 阴性组 （P < 0.05）。经单因素分析发现术前 MRI 阳性、 术前 PSA 水平、 活检 Gleason 评分、 临床分期、 病理 Gleason 评分、 SVI 和淋巴结侵犯 （LNM） 与患者术后生化复发有关 （P < 0.05）。进一步多因素 Cox 分析认为术前 MRI 阳性、 活检 Gleason 评分高和临床分期高是 RP 后生化复发的危险因素 （P < 0.05）。结论 术前 MRI 影像诊断有助于更好地预测 RP 后生化复发， 改善前列腺癌患者的预后。

Study on the predictive value of preoperative magnetic resonance imaging for biochemical recurrence after radical prostatectomy

Abstract： Objective To evaluate the suitability of preoperative magnetic resonance imaging (MRI) positivity as a pre⁃ dictor of biochemical recurrence after radical prostatectomy (RP). Methods Data of 115 diagnosed prostate cancer patients with RP from 2006 to 2013 were collected retrospectively. According to MRI results, patients were divided into MRI positive group (n=87) and MRI negative group (n=28). The preoperative clinical data were compared between two groups. Biochemi⁃ cal recurrence was defined as increase or persistence of serum prostate specific antigen (PSA) levels>0.2 μg/L after surgery. Cox proportional hazard regression model was used to analyze the risk factors associated with biochemical recurrence. Re⁃ sults The survival time was shorter in MRI positive group than that of MRI negative group. The preoperative PSA level was higher in MRI positive group than that of MRI negative group (P < 0.05). There was no significant difference in the age of pa⁃ tients between two groups. In MRI positive group, the proportion of preoperative PSA>20 μg/L , the proportion of patients at clinical stage T3, the proportion of patients with pathological Gleason score≥8, the proportion of patients with seminal vesi⁃ cle invasion (SVI) and the proportion of patients with endocrine therapy were higher than those of negative group (P < 0.05). The univariate analysis showed that preoperative MRI positivity, PSA level, biopsy Gleason score, clinical stage, pathological Gleason score, SVI level and lymph node invasion (LNM) were associated with biochemical recurrence (P < 0.05)．However, the multivariate analysis showed that only preoperative MRI positivity, biopsy Gleason score and clinical stage were indepen⁃ dent prognostic factors (P < 0.05). Conclusion Preoperative MRI positivity can predict biochemical recurrence after RP successfully, and improve the prognosis of patients.