Comparison of DCE-MRI parameters, modified Gleason score and PSA in predicting the risk of
castration resistant prostate cancer in prostate cancer patients after treatment
YAO Xiao-gang1, ZHU Pei-ju2, ZHAO Ming1, HUANG Yu-nong1, CHEN Jing1
1. Department of Radiology, the Sixth People’s Hospital of Chengdu, Chengdu 610051, China;
2. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
摘要目的：探讨DCE-MRI参数对比改良Gleason评分、PSA在预测前列腺癌患者治疗后去势抵抗性前列腺癌（CRPC）风险性所发挥的作用，为临床指导治疗提供依据。方法：选取2009年8月—2015年8月在我院就诊并接受治疗的前列腺癌患者193例，记录其年龄、DCE-MRI参数、改良Gleason评分、PSA、BMI、TNM分期。所有患者的随访期为2年，单因素分析影响前列腺癌患者预后的因素；Cox回归模型进一步分析具有统计学意义的指标对前列腺癌患者预后影响的程度；运用t检验显示前列腺癌影响因素在两组间分布的差异； ROC曲线分析Ktrans值和PSA水平在预测前列腺癌患者治疗后发生去势抵抗性前列腺癌风险性的敏感性和特异性。结果：单因素分析提示患者年龄、改良Gleason评分、PSA、DCE-MRI参数、以及TNM分期均能影响患者预后情况，差异有统计学意义（P<0.05）。Cox回归结果提示患者的DCE-MRI参数Ktrans值（P=0.027）、PSA值（P=0.028）对CRPC风险有显著影响，且Ktrans值影响程度明显高于PSA（RR=2.413 vs RR=2.012）。t检验提示预后不良组Ktrans值显著高于预后良好组（P=0.001）；预后不良组中PSA水平高于预后良好组（P=0.024）；ROC曲线下Ktrans值的AUC为0.843（95%置信区间：0.769～0.917），敏感性和特异性分别为82.14%，71.43%；PSA水平的AUC为0.752（95%置信区间：0.657～0.847），其敏感性和特异性分别为74.92%，63.42%。结论：DCE-MRI参数Ktrans水平在评估前列腺癌患者治疗后CRPC风险方面表现出较好的预测能力，有望作为前列腺癌患者的常规评估指标，为临床指导治疗提供依据。
Abstract：Objective: To investigate the role of the DCE-MRI parameters, the modified Gleason score, and PSA in predicting the risk of castration resistant prostate cancer after prostate cancer treatment, and to provide evidence for clinical treatment. Methods: From August 2009 to August 2015, 193 patients with prostate cancer were treated in our hospital, and their age, DCE-MRI parameter, modified Gleason score, PSA, BMI and TNM staging were recorded. All patients were followed up for 2 years, the single factor analysis was used to analyzed the factors affecting the prognosis of patients with prostate cancer. The Cox regression model was used to further analyze the prognostic impact of prostate cancer on the severity of the disease. T test was used to show the differences in the distribution of prostate cancer risk factors between the two groups. The sensitivity and specificity of Ktrans and PSA levels in predicting the risk of castration resistant prostate cancer after treatment for prostate cancer were analyzed using the ROC curve. Results: Univariate analysis showed that age, improved Gleason score, PSA, DCE-MRI parameters, and TNM staging all affected the prognosis of the patients, and the difference was statistically significant(P<0.05). The results of Cox regression indicated that the DCE-MRI parameter, Ktrans value(P=0.027) and PSA value(P=0.028) had significant influence on the risk of CRPC, and the influence of Ktrans value was higher than that of PSA(RR=2.413 vs RR=2.012). The t test showed that the Ktrans value in the poor prognosis group was significantly higher than that in the good prognosis group(P=0.001). The level of PSA in the poor prognosis group was higher than that in the good prognosis group(P=0.024). Under the ROC curve, the AUC of Ktrans value was 0.843(95% confidence interval: 0.769 to 0.917), and the sensitivity and specificity were 82.14% and 71.43% respectively. The AUC of PSA level was 0.752(95% confidence interval: 0.657 to 0.847), and the sensitivity and specificity were 74.92% and 63.42% respectively. Conclusion: The DCE-MRI parameter Ktrans is a better predictor of CRPC in patients with prostate cancer after treatment and is expected to serve as a routine indicator of prostate cancer, to provide a basis for clinical treatment.
姚小刚1，朱培菊2，赵 明1，黄雨农1，陈 静1. DCE-MRI参数对比改良Gleason评分、PSA预测前列腺癌患者
治疗后去势抵抗性前列腺癌的风险性[J]. 中国临床医学影像杂志, 2018, 29(11): 803-807.
YAO Xiao-gang1, ZHU Pei-ju2, ZHAO Ming1, HUANG Yu-nong1, CHEN Jing1. Comparison of DCE-MRI parameters, modified Gleason score and PSA in predicting the risk of
castration resistant prostate cancer in prostate cancer patients after treatment. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(11): 803-807.
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