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Zhou L, Xu LL, Zheng LL, Chen C, Xu L, Zeng JL, Li SY. Predictors of Gleason Grading Group Upgrading in Low-Risk Prostate Cancer Patients From Transperineal Biopsy After Radical Prostatectomy. Acad Radiol 2024; 31:2838-2847. [PMID: 38233258 DOI: 10.1016/j.acra.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the predictors of Gleason Grading Group (GGG) upgrading in low-risk prostate cancer (Gleason score=3 + 3) from transperineal biopsy after radical prostatectomy (RP). MATERIALS AND METHODS The clinical data of 160 patients who underwent transperineal biopsy and RP from January 2017 to December 2022 were retrospectively analyzed. First, univariate and multivariate logistic regression analysis were used to obtain independent predictors of postoperative GGG upgrading. Then receiver operating characteristic curve was used to evaluate the diagnostic efficacy of predictors. Finally, Linear-by-Linear Association test was used to analyze the risk trends of patients in different predictor groups in the postoperative GGG. RESULTS In this study, there were 81 cases (50.6%) in the GGG concordance group and 79 cases (49.4%) in the GGG upgrading group. Univariate analysis showed age, free/total prostate-specific antigen (f/tPSA), proportion of positive biopsies, positive target of magnetic-resonance imaging (MRI) and positive target of contrast-enhanced ultrasound had significant effects on GGG upgrading (all P < .05). In multivariate logistic regression analysis, age (odds ratio [OR]=1.066, 95%CI=1.007-1.127, P = .027), f/tPSA (OR=0.001, 95%CI=0-0.146, P = .001) and positive target of MRI (OR=3.005, 95%CI=1.353-76.674, P = .007) were independent predictors. The prediction model (area under curve=0.751 P < .001) had higher predictive efficacy than all independent predictors. The proportion of patients in exposed group of different GGG increased with the level of GGG, but decreased in nonexposed group, and the linear trend was significantly different (all P < .001). CONCLUSION Age, f/tPSA, and positive target of MRI were independent predictors of postoperative GGG upgrading. The predictive model constructed had the best diagnostic efficacy.
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Affiliation(s)
- Ling Zhou
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Li-Long Xu
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Lin-Lin Zheng
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (C.C.)
| | - Li Xu
- Department of Urology Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (L.X.)
| | - Ji-Ling Zeng
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (J.Z.)
| | - Shi-Yan Li
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.).
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Zheng T, Sun H, Tang Y, Bi K, Zeng Y, Wang J, Yan L. Comparing histology between prostate cognitive fusion targeted biopsy and radical prostatectomy: exploring risk factors of Gleason score upgrading in Chinese patients. J Cancer Res Clin Oncol 2023; 149:18029-18037. [PMID: 37979056 DOI: 10.1007/s00432-023-05506-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To explore and identify the relevant clinical and pathological predictors leading to biopsy Gleason score upgrading (GSU) in cognitive fusion targeted biopsy (COG-TB) in Chinese patients. METHODS Clinical and pathological information of 496 patients who underwent COG-TB and radical prostatectomy (RP) in our hospital from January 2020 to September 2023 were retrospectively compiled and analyzed. In this study, we screened valuable predictors through univariable and multivariable logistic regression analyses and then constructed predictive models. We draw nomograms to visualize the predictive models. In addition, the discriminatory power of the model was assessed using receiver operating characteristic (ROC) curves. Finally, calibration curves and decision curve analysis (DCA) were used to evaluate the predictive power of the model and the net benefits it could deliver. RESULTS Out of the 496 patients eligible for the study, 279 had a consistent Gleason score (GS) on biopsy and postoperative GS, 191 experienced GSU, and 26 experienced downgrading. Significant associations for GSU were identified for five risk factors through multivariable logistic regression analyses, which included age, prostate volume, BMI, tumor percentage in biopsy tissue, and tumor location. Our model had excellent discriminatory power through ROC analysis. Calibration curves and DCA showed that our model was well calibrated and provided certain benefits for patient treatment decisions. CONCLUSION Age, prostate volume, BMI, tumor percentage in biopsy tissue, and tumor location are risk indicators for predicting GSU in COG-TB. Our prediction model is more suitable for Chinese patients and can assist in accurately evaluating biopsy GS and developing effective treatment plans.
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Affiliation(s)
- Tianyun Zheng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Huaibin Sun
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Yueqing Tang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Kaipeng Bi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Yuan Zeng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Junyan Wang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Lei Yan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Zhou J, Chen H, Wu Y, Shi B, Ding J, Qi J. Plasma IL-6 and TNF-α levels correlate significantly with grading changes in localized prostate cancer. Prostate 2022; 82:531-539. [PMID: 35037273 DOI: 10.1002/pros.24299] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the effect of inflammatory markers in blood such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) on the Gleason score (GS) changes in patients with prostate cancer (PCa) after radical prostatectomy (RP), we conducted this study. PATIENTS AND METHODS From November 2012 to September 2021, a total of 237 patients underwent RP at our institution. Blood samples from all patients were collected within 1 week before surgery. Preoperative clinical characteristics include age, serum IL-6 and TNF-α, neutrophil-to-lymphocyte ratio, C-reactive protein, the platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, the prostate imaging reporting and data system (PI-RADS) score, prostate-specific antigen, and biopsy GS were assessed. Univariate and multivariate logistic regression analyzes were used to determine the risk factors of GS changes after RP. The efficiency of this prediction model was identified with the area under the curve of the receiver operating characteristic curve. RESULTS Seventy-three patients (30.8%) had GS upgraded in the overall cohort, and 55 patients (23.2%) had GS downgraded. In comparing PCa patients with and without GS upgraded, multivariate logistic regression analysis showed that serum TNF-α (odds ratio [OR]: 2.518, p = 0.019) and IL-6 (OR: 0.478, p = 0.023) were independent factors predicting the occurrence of GS upgrade. We also compared the characteristics of patients with GS upgraded and GS downgraded; multivariate logistic regression analysis also demonstrated significant differences in serum IL-6 and TNF-α between these two groups (all p < 0.05). In addition, we found that low prostate volume and biopsy GS ≥ 7 were significantly associated with higher PI-RADS sores in multivariate analysis. CONCLUSION The high expression of serum TNF-α level is positively correlated with GS upgraded in PCa patients. High expression of serum IL-6 level is negatively correlated with GS upgraded in PCa patients and positively related with GS downgraded.
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Affiliation(s)
- Jiatong Zhou
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haojie Chen
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyuan Wu
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bowen Shi
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Ding
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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The volume and thickness of preprostatic fat on MRIs are not associated with prostate cancer aggressiveness in men undergoing radical prostatectomy. Prog Urol 2022; 32:341-353. [DOI: 10.1016/j.purol.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
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Evaluation of multiparametric prostate magnetic resonance imaging findings in patients with a Gleason score of 6 in transrectal ultrasonography-guided biopsy. Pol J Radiol 2021; 86:e608-e613. [PMID: 34876942 PMCID: PMC8634417 DOI: 10.5114/pjr.2021.111082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose We aimed to evaluate prostate multiparametric magnetic resonance imaging (mpMRI) findings of patients with a Gleason score (GS) of 6 and effectiveness of MRI based on the final pathology result in patients undergoing radical prostatectomy (RP). Material and methods mpMRI findings of 80 patients who had a GS of 3 + 3 and who underwent mpMRI were evaluated retrospectively. The mpMRI were scored according to the PIRADS v2.1 guidelines. The patients were divided into those with a high probability of clinically significant cancer (CSC) (PI-RADS 4-5) and those with a low probability of CSC (PI-RADS 2-3). Results Of the 80 patients, 33.8% had PI-RADS 2-3, and 66.2% had PI-RADS 4-5 lesions. There was a significant difference between the groups in prostate specific antigen (PSA) value, PSA density, patient age, and tumour percentage on biopsy. When the pathology results were taken as the gold standard in the group that underwent RP, sensitivity, specificity, and accuracy of mpMRI were calculated as 94.74%, 100%, and 96.3%, respectively, an increase in the final GS was found in 9 (33.3%) of the 27 patients, and 70.35% of patients were identified as having CSC. Conclusions PI-RADS 4-5 scores have high sensitivity and negative predictive value in the diagnosis of CSC. mpMRI is a reliable and non-invasive diagnostic method that can complement biopsy results in decision-making in patients who are initially evaluated as low risk.
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Zhang B, Wu S, Zhang Y, Guo M, Liu R. Analysis of risk factors for Gleason score upgrading after radical prostatectomy in a Chinese cohort. Cancer Med 2021; 10:7772-7780. [PMID: 34528767 PMCID: PMC8559471 DOI: 10.1002/cam4.4274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background To study the risk factors of Gleason score upgrading (GSU) after radical prostatectomy (RP) in a Chinese cohort. Methods The data of 637 patients who underwent prostate biopsy and RP in our hospital from January 2014 to January 2021 were retrospectively analyzed. The age, body mass index (BMI), prostate‐specific antigen (PSA) level, testosterone (TT) level, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), eosinophil‐to‐lymphocyte ratio (ELR), aspartate aminotransferase/alanine transaminase (AST/ALT) ratio, clinical stage, the biopsy method, and pathological characteristics of specimens after biopsy and RP were collected for all patients. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of GSU after RP. The predictive efficacy was verified with the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. We performed the analysis separately in the overall cohort and in the cohort with Gleason score (GS) = 6. Results In the overall cohort, 177 patients (27.79%) had GSU, and in the GS = 6 cohort, 68 patients (60.18%) had GSU. Multivariate logistic regression analysis showed that in the overall cohort, clinical stage ≥T2c (OR = 3.201, p < 0.001), the number of positive cores ≥3 (OR = 0.435, p = 0.04), and positive rate of biopsy (OR = 0.990, p = 0.016) can affect whether GS is upgraded, and the AUC of the combination of the three indicators for predicting the occurrence of GSU was 0.627. In the GS = 6 cohort, multivariate logistic regression analysis showed that clinical stage ≥T2c (OR = 4.690, p = 0.001) was a risk factor for GSU, and the AUC predicted to occur GSU is 0.675. Conclusion Clinical stage ≥T2c, the number of positive cores <3, and lower positive rate of biopsy are the risk factors of GSU. This study may provide some references for clinicians to judge the accuracy of biopsy pathological grading and formulate treatment strategies, but the specific effect still needs clinical practice certification.
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Affiliation(s)
- Baoling Zhang
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Shangrong Wu
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Yang Zhang
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Mingyu Guo
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Ranlu Liu
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
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Chung DY, Kim MS, Lee JS, Goh HJ, Koh DH, Jang WS, Hong CH, Choi YD. Clinical Significance of Multiparametric Magnetic Resonance Imaging as a Preoperative Predictor of Oncologic Outcome in Very Low-Risk Prostate Cancer. J Clin Med 2019; 8:jcm8040542. [PMID: 31010237 PMCID: PMC6518039 DOI: 10.3390/jcm8040542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
Currently, multiparametric magnetic resonance imaging (mpMRI) is not an indication for patients with very low-risk prostate cancer. In this study, we aimed to evaluate the usefulness of mpMRI as a diagnostic tool in these patients. We retrospectively analyzed the clinical and pathological data of individuals with very low-risk prostate cancer, according to the NCCN guidelines, who underwent mpMRI before radical prostatectomy at our institution between 2010 and 2016. Patients who did not undergo pre-evaluation with mpMRI were excluded. We analyzed the factors associated with biochemical recurrence (BCR) using Cox regression model, logistic regression analysis, and Kaplan–Meier curve. Of 253 very low-risk prostate cancer patients, we observed 26 (10.3%) with BCR during the follow-up period in this study. The median follow-up from radical prostatectomy was 53 months (IQR 33–74). The multivariate Cox regression analyses demonstrated that the only factor associated with BCR in very low-risk patients was increase in the pathologic Gleason score (GS) (HR: 2.185, p-value 0.048). In addition, multivariate logistic analyses identified prostate specific antigen (PSA) (OR: 1.353, p-value 0.010), PSA density (OR: 1.160, p-value 0.013), and suspicious lesion on mpMRI (OR: 1.995, p-value 0.019) as the independent preoperative predictors associated with the pathologic GS upgrade. In our study, the pathologic GS upgrade after radical prostatectomy in very low-risk prostate cancer patients demonstrated a negative impact on BCR and mpMRI is a good prognostic tool to predict the pathologic GS upgrade. We believe that the implementation of mpMRI would be beneficial to determine the treatment strategy for these patients.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, 366 Seohae-daero, Jung-gu, Incheon 22332, Korea.
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Min Seok Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Jong Soo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Hyeok Jun Goh
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Dong Hoon Koh
- Department of Urology, Konyang University College of Medicine, 158 Gwanjeodong-ro, Daejeon 35365, Korea.
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Chang Hee Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
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