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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (4): 567-574. doi: 10.19723/j.issn.1671-167X.2024.04.004

• 论著 • 上一篇    下一篇

双参数MRI改良PI-RADS评分4分和5分病灶的最大径对临床有意义前列腺癌的预测效果

田宇轩1,阮明健1,刘毅1,李德润1,吴静云2,沈棋1,范宇1,3,*(),金杰1,*()   

  1. 1. 北京大学第一医院泌尿外科，北京大学泌尿外科研究所，国家泌尿男生殖系肿瘤中心，北京 100034
    2. 北京大学第一医院影像科，北京 100034
    3. 北京大学第一医院临床药物试验机构，北京 100034
  • 收稿日期:2024-03-20 出版日期:2024-08-18 发布日期:2024-07-23
  • 通讯作者: 范宇,金杰 E-mail:dantefanbmu@126.com;jinjie@vip.163.com
  • 基金资助:
    中央高水平医院临床科研业务费(北京大学第一医院院内交叉临床研究专项)(2022CR16)

Predictive effect of the dual-parametric MRI modified maximum diameter of the lesions with PI-RADS 4 and 5 on the clinically significant prostate cancer

Yuxuan TIAN1,Mingjian RUAN1,Yi LIU1,Derun LI1,Jingyun WU2,Qi SHEN1,Yu FAN1,3,*(),Jie JIN1,*()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Radiology, Peking University First Hospital, Beijing 100034, China
    3. Drug Clinical Trial Institution, Peking University First Hospital, Beijing 100034, China
  • Received:2024-03-20 Online:2024-08-18 Published:2024-07-23
  • Contact: Yu FAN,Jie JIN E-mail:dantefanbmu@126.com;jinjie@vip.163.com
  • Supported by:
    the National High Level Hospital Clinical Research Funding (Interdepartmental Clinical Research Project of Peking University First Hospital)(2022CR16)

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摘要：

目的: 评估前列腺影像报告和数据评分系统(prostate imaging reporting and data system，PI-RADS)中将病灶最大径15 mm作为4分升级为5分标准的合理性并进行改良，以提升对临床有意义前列腺癌(clinical significant prostate cancer，csPCa)的预测效果。方法: 回顾性分析北京大学第一医院2019—2022年间接受前列腺MRI检查及穿刺的患者，将这组患者作为训练集，2023年的患者作为验证集，对病灶进行定位及测量最大径。采用受试者操作特征(receiver operating characteristics，ROC)曲线计算出病灶最大径预测csPCa的曲线下面积(area under curve，AUC)及最佳截断值，采用倾向性评分匹配(propensity score matching, PSM)缩小组间差异，在验证集中进行诊断效能的比较。结果: 训练集的589例患者中，358例(60.8%)的病灶位于外周带，231例(39.2%)位于移行带，496例(84.2%)为csPCa病变。外周带病灶的中位直径小于移行带病灶(14 mm vs. 19 mm，P < 0.001)。ROC分析最大径对csPCa的预测效果，外周带病灶(AUC=0.709)与移行带病灶(AUC=0.673)相比差异无统计学意义(P=0.585)，计算得出外周带病灶的截断值为11.5 mm，移行带病灶为16.5 mm。通过在验证集中计算截断值对应的约登指数(Youden index)，发现按病灶位置进行分层可以取得更好的预测效果，计算净重新分类指数(net reclassification index, NRI)为0.170。结论: 将15 mm作为病灶PI-RADS评分4分升级为5分的标准过于笼统，外周带病灶的截断值小于移行带病灶，应考虑对不同位置的病灶分开设定截断值。

关键词: 前列腺肿瘤, 多参数磁共振成像, 活组织检查, 临床决策规则, 前列腺影像报告和数据评分系统

Abstract:

Objective: To assess the rationality of the maximum lesion diameter of 15 mm in prostate imaging reporting and data system (PI-RADS) as a criterion for upgrading a lesion from category 4 to 5 and improve it to enhance the prediction of clinically significant prostate cancer (csPCa). Methods: In this study, the patients who underwent prostate magnetic resonance imaging (MRI) and prostate biopsy at Peking University First Hospital from 2019 to 2022 as a development cohort, and the patients in 2023 as a validation cohort were reviewed. The localization and maximum diameter of the lesion were fully evaluated. The area under the curve (AUC) and the cut-off value of the maximum diameter of the lesion to predict the detection of csPCa were calculated from the receiver operating characteristics (ROC) curve. Confounding factors were reduced by propensity score matching (PSM). Diagnostic efficacy was compared in the validation cohort. Results: Of the 589 patients in the development cohort, 358 (60.8%) lesions were located in the peripheral zone and 231 (39.2%) were located in the transition zone, and 496 (84.2%) patients detected csPCa. The median diameter of the lesions in the peripheral zone was smaller than that in the transition zone (14 mm vs. 19 mm, P < 0.001). In the ROC analysis of the maximal diameter on the csPCa prediction, there was no statistically significant difference between the peri-pheral zone (AUC=0.709) and the transition zone (AUC=0.673, P=0.585), and the cut-off values were calculated to be 11.5 mm for the peripheral zone and 16.5 mm for the migrating zone. By calcula-ting the Youden index for the cut-off values in the validation cohort, we found that the categorisation by lesion location led to better predictive results. Finally, the net reclassification index (NRI) was 0.170. Conclusion: 15 mm as a criterion for upgrading the PI-RADS score from 4 to 5 is reasonable but too general. The cut-off value for peripheral zone lesions is smaller than that in transitional zone. In the future consideration could be given to setting separate cut-off values for lesions in different locations.

Key words: Prostatic neoplasms, Multiparametric magnetic resonance imaging, Biopsy, Clinical decision rules, Prostate imaging reporting and data system

中图分类号: 

  • R737.25

图1

PI-RADS评分为4分病灶的前列腺磁共振影像"

表1

研究对象的临床资料特征"

Characteristics (before PSM) Development cohort (n=589) Validation cohort (n=254)
Age/years 69.00 (64.00, 75.50) 68.00 (63.00, 74.00)
Diameter of lesion/mm 16.00 (12.00, 22.00) 14.00 (9.00, 19.00)
PSA/(μg/L) 11.20 (7.37, 18.39) 10.58 (7.02, 15.35)
Prostate volume/mL 44.27 (35.96, 60.15) 43.00 (33.70, 60.99)
csPCa 496 (84.2) 184 (72.4)
ciPCa 39 (6.6) 17 (6.7)
nPCa 54 (9.2) 53 (20.9)
Location
  Peripheral zone 358 (60.8) 189 (74.4)
  Transition zone 231 (39.2) 65 (25.6)
PI-RADS score
  4 307 (52.1) 143 (56.3)
  5 254 (47.9) 111 (43.7)

表2

训练集患者的临床资料特征"

Characteristics (before PSM) Peripheral zone (n=358) Transitional zone (n=231) P value
Age/years 69.00 (64.00, 76.00) 69.00 (64.00, 75.00) 0.936
Diameter of lesion/mm 14.00 (10.00, 19.00) 19.00 (15.00, 24.00) < 0.001
PSA/(μg/L) 10.23 (6.71, 16.43) 12.69 (8.67, 21.36) < 0.001
Prostate volume/mL 43.06 (35.10, 58.91) 45.64 (37.84, 62.11) 0.087
csPCa < 0.001
  0 37 (10.3) 56 (24.2)
  1 321 (89.7) 175 (75.8)
PI-RADS score 0.079
  4 197 (55.0) 110 (47.6)
  5 161 (45.0) 121 (52.4)

表3

验证集患者的临床资料特征"

Characteristics Peripheral zone (n=189) Transitional zone (n=65) P value
Age/years 68.00 (63.00, 74.00) 68.00 (64.00, 74.00) 0.812
Diameter of lesion/mm 14.00 (9.00, 18.00) 18.00 (13.00, 23.50) < 0.001
PSA/(μg/L) 10.30 (6.58, 14.09) 11.15 (7.51, 18.22) 0.017
Prostate volume/mL 42.00 (32.50, 60.42) 47.90 (38.00, 64.15) 0.125
csPCa < 0.001
  0 42 (22.2) 28 (43.1)
  1 147 (77.8) 37 (56.9)
PI-RADS score 0.297
  4 110 (58.2) 33 (50.8)
  5 79 (41.8) 32 (49.2)

图2

根据病灶最大径预测csPCa的ROC曲线"

表4

训练集患者病灶最大径的最佳截断值及AUC"

Items AUC Cut-off value/mm Sensitivity (95%CI) Specificity (95%CI) Youden index
All 0.596 16.5 0.476 (0.431-0.521) 0.699 (0.594-0.787) 0.175
Peripheral zone 0.709 11.5 0.713 (0.660-0.762) 0.622 (0.448-0.771) 0.335
Transition zone 0.673 16.5 0.703 (0.628-0.768) 0.607 (0.468-0.732) 0.310

表5

训练集患者不同截断值对应的灵敏度及特异度"

Cut-off value/mm Peripheral zone Transition zone
Sensitivity Specificity Sensitivity Specificity
10.5 0.763 0.541 0.977 0.107
11.5 0.713 0.622 0.966 0.125
12.5 0.642 0.649 0.954 0.125
13.5 0.573 0.703 0.937 0.125
14.5 0.477 0.784 0.880 0.196
15.5 0.393 0.838 0.789 0.446
16.5 0.352 0.838 0.703 0.607
17.5 0.299 0.865 0.611 0.661
18.5 0.268 0.865 0.566 0.679
19.5 0.246 0.865 0.520 0.696
20.5 0.196 0.892 0.457 0.732

表6

倾向性评分匹配后训练集患者的临床特征"

Characteristics (after PSM) Peripheral zone (n=214) Transitional zone (n=214) P value
Age/years 70.00 (63.75, 76.00) 69.50 (64.00, 75.00) 0.657
Diameter of lesion/mm 15.00 (11.00, 20.00) 18.50 (15.00, 23.25) < 0.001
PSA/(μg/L) 12.14 (7.37, 20.42) 12.55 (8.51, 20.35) 0.841
Prostate volume/mL 42.56 (34.64, 60.48) 45.54 (37.93, 60.41) 0.387
csPCa 0.541
  0 37 (17.3) 41 (19.2)
  1 177 (82.7) 173 (80.8)
PI-RADS score 0.525
  4 95 (44.4) 101 (47.2)
  5 119 (55.6) 113 (52.8)

表7

倾向性评分匹配后训练集病灶最大径的最佳截断值及AUC"

Items AUC Cut-off value/mm Sensitivity (95%CI) Specificity (95%CI) Youden index
All 0.706 16.5 0.583 (0.529-0.635) 0.756 (0.644-0.843) 0.339
Peripheral zone 0.767 11.5 0.808 (0.741-0.862) 0.622 (0.448-0.771) 0.430
Transition zone 0.712 16.5 0.699 (0.624-0.765) 0.683 (0.518-0.814) 0.382

表8

训练集病灶最大径的最佳截断值验证"

Items Cut-off value in development cohort 15 mm
Sensitivity (95%CI) Specificity (95%CI) Youden index Sensitivity (95%CI) Specificity (95%CI) Youden index
All 0.402 (0.331-0.477) 0.700 (0.577-0.801) 0.102 0.538 (0.463-0.611) 0.629 (0.504-0.739) 0.167
Peripheral zone 0.694 (0.612-0.766) 0.643 (0.480-0.780) 0.337 0.497 (0.414-0.580) 0.786 (0.628-0.892) 0.283
Transition zone 0.622 (0.448-0.771) 0.536 (0.342-0.720) 0.158 0.703 (0.528-0.836) 0.393 (0.221-0.593) 0.096
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
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Email： xbbjb2@bjmu.edu.cn

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