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Chen X, Wang C, Chen Y, Qian C, Huang R, Bao J, Lin Y, Hou J, Huang Y, Wei X. Clinical risk prediction model and external validation of positive surgical margin in laparoscopic radical prostatectomy based on MRI lesion location. Clin Transl Oncol 2024; 26:1998-2005. [PMID: 38472559 DOI: 10.1007/s12094-024-03424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To clarify the composition of lesions in different magnetic resonance imaging (MRI) partitions of positive surgical margins (PSM) after laparoscopic radical prostatectomy, explore the influence of lesion location on PSM, and construct a clinical prediction model to predict the risk of PSM. MATERIALS AND METHODS This retrospective cohort study included 309 patients who underwent laparoscopic radical prostatectomy from 2018 to 2021 in our center was performed. 129 patients who met the same criteria from January to September 2022 were external validation cohorts. RESULTS The incidence of PSM in transition zone (TZ) lesions was higher than that in peripheral zone (PZ) lesions. The incidence of PSM in the middle PZ was lower than that in other regions. Prostate specific antigen (PSA), clinical T-stage, the number of positive cores, international society of urological pathology (ISUP) grade (biopsy), MRI lesion location, extracapsular extension, seminal vesicle invasion (SVI), pseudo-capsule invasion (PCI), long diameter of lesions, lesion volume, lesion volume ratio, PSA density were related to PSM. MRI lesion location and PCI were independent risk factors for PSM. Least absolute shrinkage and selection operator (LASSO) regression was used to construct a clinical prediction model for PSM, including five variables: the number of positive cores, SVI, MRI lesion location, long diameter of lesions, and PSA. CONCLUSION The positive rate of surgical margin in middle PZ was significantly lower than that in other regions, and MRI lesion location was an independent risk factor for PSM.
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Affiliation(s)
- Xin Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 215006, People's Republic of China
| | - Chaozhong Wang
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Yongchang Chen
- Department of Urology, Changshu No. 2 People's Hospital, Suzhou, 215006, People's Republic of China
| | - Chengbo Qian
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Renpeng Huang
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Yuxin Lin
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 215006, People's Republic of China.
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
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Jin D, Kong XQ, Zhu YJ, Chen ZX, Wang XM, Xu CH, Pu JX, Hou JQ, Huang YH, Ji FH, Huang C. Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy. Asian J Androl 2024; 26:409-414. [PMID: 38376191 PMCID: PMC11280210 DOI: 10.4103/aja202385] [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: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024] Open
Abstract
This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies, namely chatting while under local anesthesia (Chat-LA), total intravenous anesthesia (TIVA), and general anesthesia with laryngeal mask airway (GA-LMA), employed in transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion prostate biopsy (TP-MUF-PB). A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University (Suzhou, China). Clinical data and outcomes, including total costs, complications, and quality-adjusted life years (QALYs), were compared. Probability sensitivity and subgroup analyses were also performed. Chat-LA was found to be the most cost-effective option, outperforming both TIVA and GA-LMA. However, subgroup analyses revealed that in younger patients (under 65 years old) and those with smaller prostate volumes (<40 ml), TIVA emerged as a more cost-effective strategy. While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB, personalization of anesthesia strategies is crucial, considering specific patient demographics such as age and prostate volume.
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Affiliation(s)
- Di Jin
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiao-Qi Kong
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ya-Juan Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Zong-Xin Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xi-Ming Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Cai-Hua Xu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jin-Xian Pu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Jian-Quan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Yu-Hua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Fu-Hai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chen Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Zhou Y, Li T, Muheiyati G, Duan Y, Xiao S, Gao Y, Tao N, An H. Triglyceride-glucose index is a predictor of the risk of prostate cancer: a retrospective study based on a transprostatic aspiration biopsy population. Front Endocrinol (Lausanne) 2024; 14:1280221. [PMID: 38260162 PMCID: PMC10801031 DOI: 10.3389/fendo.2023.1280221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Current research suggests that prostate cancer (PCa), one of the most common cancers in men, may be linked to insulin resistance (IR).Triglyceride-glucose index (TyG index) was made for a marker of insulin resistance. We investigated the relationship between the TyG index and the risk of PCa. Objective To assess the correlation and dose-response relationship between TyG index and prostate cancer. Method Retrospectively, 316 patients who required prostate biopsy puncture in the First Affiliated Hospital of Xinjiang Medical University from March 2017 to July 2021 were collected, and the relationship between factors such as the TyG index and prostate cancer was analyzed by Logistic regression model combined with a restricted cubic spline. Results (1) The differences in age, initial PSA and TyG index between the two groups were statistically significant; (2) Logistic regression results showed that the risk of prostate cancer in the highest quartile of the TyG index (Q4) was 3.387 times higher than that in the lowest quartile (Q1) (OR=3.387,95% CI [1.511,7.593], P=0.003); (3) The interaction results showed a significant interaction between the TyG index Q4 group and age with the risk of developing prostate cancer (P for interaction<0.001). (4) The results of the restricted cubic spline showed a linear dose-response relationship between the TyG index and the risk of prostate cancer; (5) The Receiver operating characteristic (ROC) curve results showed that the area under the curve (AUC) of the TyG index combined with initial PSA and age was 0.840, with a sensitivity and specificity of 62.5% and 93.3%, respectively. Conclusion TyG index and age are risk factors for prostate cancer, and the interaction between the TyG index and different risk factors may increase the risk of prostate cancer. TyG index has some predictive value for the risk of prostate cancer, and the risk of prostate cancer can be reduced by controlling the levels of blood lipids and blood glucose.
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Affiliation(s)
- Yijie Zhou
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tianqi Li
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Guliman Muheiyati
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yajun Duan
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Songtao Xiao
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yi Gao
- School of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ning Tao
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
- Department of Epidemiological Statistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hengqing An
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Zhang Z, Hu C, Lin Y, Song O, Gong D, Zhang X, Wang N. Clinical and Radiological Factors for Predicting Clinically Significant Prostate Cancer in Biopsy-Naive Patients With PI-RADS 3 Lesions. Technol Cancer Res Treat 2024; 23:15330338241246636. [PMID: 38629205 PMCID: PMC11025422 DOI: 10.1177/15330338241246636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This study intends to examine the anticipatory power of clinical and radiological parameters in detecting clinically significant prostate cancer in patients demonstrating Prostate Imaging Reporting and Data System 3 lesions. METHODS This was a retrospective study. The study included participation from 453 patients at the First Affiliated Hospital of Soochow University, sampled between September 2017 through August 2022. Each patient underwent a routine 12-core prostate biopsy followed by a 2 to 5 core fusion-targeted biopsy. We utilized both univariate and multivariate logistic regression analyses to identify the parameters that have a correlation with clinically significant prostate cancer. The predictive ability of these parameters was assessed using the receiver operating characteristic curve, leading to the creation of a nomogram. RESULTS Clinically significant prostate cancer was detected in 68 out of 453 patients with Prostate Imaging Reporting and Data System 3 lesions (15.01%). Among Prostate Imaging Reporting and Data System 3a and 3b patients, 4.78% (3.09% of the total) and 33.75% (11.92% of the total), respectively, had clinically significant prostate cancer. Systematic biopsy improved prostate cancer and clinically significant prostate cancer detection rates by 7.72% and 3.09%, respectively, compared to targeted biopsy. Without systematic biopsy, there would be an undetected rate of 15% for prostate cancer and 8.13% for clinically significant prostate cancer in Prostate Imaging Reporting and Data System 3b patients. Several clinical parameters, including age, prostate-specific antigen density, lesion volume, apparent diffusion coefficient, and digital rectal examination, were statistically significant in the logistic regression analysis for clinically significant prostate cancer. The individual diagnostic accuracies of these parameters for clinically significant prostate cancer were 0.648, 0.645, 0.75, 0.763, and 0.7, respectively, but their combined accuracy improved to 0.866. A well-fit nomogram based on the identified risk factors was constructed (χ2 = 10.254, P = .248). CONCLUSION The combination of age, prostate-specific antigen density, lesion volume, apparent diffusion coefficient, and digital rectal examination presented a higher diagnostic value for clinically significant prostate cancer than any single parameter in patients with Prostate Imaging Reporting and Data System 3 lesions. Systematic biopsy proved crucial for biopsy-naive patients with Prostate Imaging Reporting and Data System 3 lesions and should not be omitted.
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Affiliation(s)
- Zhiyu Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Can Hu
- Department of Urology, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Yuxin Lin
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ouyang Song
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongkui Gong
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Nan Wang
- Department of Reproductive Medicine Center, The First Affiliated Hospital of Soochow University, Suzhou, China
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Chen X, Li W, Yang J, Huang C, Zhou C, Chen Y, Lin Y, Hou J, Huang Y, Wei X. Extracapsular extension of transitional zone prostate cancer miss-detected by multiparametric magnetic resonance imaging. J Cancer Res Clin Oncol 2023; 149:6943-6952. [PMID: 36847840 DOI: 10.1007/s00432-023-04573-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/04/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To demonstrate the importance of extracapsular extension (ECE) of transitional zone (TZ) prostate cancer (PCa), examine the causes of its missed detection by Mp-MRI, and develop a new predictive model by integrating multi-level clinical variables. MATERIALS AND METHODS This retrospective study included 304 patients who underwent laparoscopic radical prostatectomy after 12 + X needle transperineal transrectal ultrasound (TRUS)-MRI-guided targeted prostate biopsy from 2018 to 2021 in our center was performed. RESULTS In this study, the incidence rates of ECE were similar in patients with MRI lesions in the peripheral zone (PZ) and TZ (P = 0.66). However, the missed detection rate was higher in patients with TZ lesions than in those with PZ lesions (P < 0.05). These missed detections result in a higher positive surgical margin rate (P < 0.05). In patients with TZ lesions, detected MP-MRI ECE may have grey areas: the longest diameters of the MRI lesions were 16.5-23.5 mm; MRI lesion volumes were 0.63-2.51 ml; MRI lesion volume ratios were 2.75-8.86%; PSA were 13.85-23.05 ng/ml. LASSO regression was used to construct a clinical prediction model for predicting the risk of ECE in TZ lesions from the perspective of MRI and clinical features, including four variables: the longest diameter of MRI lesions, TZ pseudocapsule invasion, ISUP grading of biopsy pathology, and number of positive biopsy needles. CONCLUSIONS Patients with MRI lesions in the TZ have the same incidence of ECE as those with lesions in the PZ, but a higher missed detection rate.
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Affiliation(s)
- Xin Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Wei Li
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Jiajian Yang
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Chen Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Chenchao Zhou
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Yongchang Chen
- Department of Urology, Changshu No. 2 People's Hospital, Suzhou, 215006, People's Republic of China
| | - Yuxin Lin
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 215006, People's Republic of China.
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
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