Optimizing D’Amico risk groups in radical prostatectomy through the addition of magnetic resonance imaging data

Autor: Zudaire Jj, J.M. Velis, Ignacio Pascual, A. Rincón, A. Tienza, R. Algarra, B. Zudaire
Rok vydání: 2014
Předmět:
Zdroj: Actas Urológicas Españolas (English Edition). 38:594-599
ISSN: 2173-5786
Popis: Objectives To improve the predictive efficacy of the D’Amico risk classification system with magnetic resonance imaging (MRI) of the pelvis. Materials and methods We studied 729 patients from a series of 1310 radical prostatectomies for T1–T2 prostate cancer who underwent staging pelvic MRI. Each patient was classified with T2, T3a or T3b MRI, and N (+) patients were excluded. We identified the therapeutic factors that affected the biochemical progression-free survival (BPFS) time (prostate specific antigen [PSA] levels >0.4 ng/mL) using a univariate and multivariate study with Cox models. We attempted to improve the predictive power of the D’Amico model (low risk: T1; Gleason 2–6; PSA levels 20 ng/mL). Results In the univariate study, the clinical factors that influenced BPFS were the following: Gleason 7 (HR: 1.7); Gleason 8–10 (HR: 2.9); T2 (HR: 1.6); PSA levels 10–20 (HR: 2); PSA levels >20 (HR: 4.3); D’Amico intermediate (HR: 2.1) and high (HR: 4.8) risk; T3a MRI (HR: 2.3) and T3b MRI (HR: 4.5). In the multivariate study, the only variables that affected BPFS were the following: D’Amico intermediate risk (HR: 2; 95% CI 1.2–3.3); D’Amico high risk (HR: 4.1; 95% CI 2.4–6.8); T3a MRI (HR: 1.9; 95% CI 1.2–2.9) and T3b MRI (HR: 3.9; 95% CI 2.5–6.1). In predictive model using the multivariate Cox models, we assessed the weight of each variable. A value of 1 was given to D’Amico low risk and T2 MRI; a value of 2 was given to D’Amico intermediate risk and T3a MRI and a value 3 was given to D’Amico high risk and T3b MRI. Each patient had a marker that varied between 2 and 6. The best model included 3 groups, as follows: 494 (67.7%) patients in group 1, with a score of 2–3 points (HR, 1), a BPFS of 86% ± 2% and 79% ± 2% at 5 and 10 years, respectively; 179 (24.6%) patients in group 2, with a score of 4 points (HR, 3), a BPFS of 60% ± 4% and 54% ± 5% at 5 and 10 years, respectively; and 56 (7.7%) patients in group 3, with a score of 5–6 points (HR, 9.3), a BPFS of 29% ± 8% and 19% ± 7% at 5 and 10 years, respectively. The median BPFS time was 1.5 years. Conclusion MRI data significantly improve the predictive capacity of BPFS when using the D’Amico model data.
Databáze: OpenAIRE
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