Analysis of risk factors for extraprostatic extension in clinically localized prostate cancer

doi:10.3877/cma.j.issn.1674-3253.2023.04.003

Abstract

Abstract:

Objective

To analysis of risk factors for extraprostatic extension (EPE) in clinically localized prostate cancer to improve the accuracy of preoperative prediction of EPE.

Methods

The clinical data of 222 patients who underwent radical prostatectomy for clinically localized prostate cancer in the First Hospital of Shanxi Medical University from August 2018 to November 2021 were retrospectively analyzed. Univariate and multivariate logistic regression analysis were performed to investigate the independent risk factors affecting EPE, and receiver operating characteristic (ROC) curves were plotted to calculate and compare the performance of relevant indicators in predicting EPE.

Results

The percentage of biopsy positive cores (PBPC) and prostate-specific antigen (PSA) were independent risk factors for EPE, with AUC values of 0.79 (95%CI: 0.73-0.84) and 0.56 (95%CI: 0.49-0.62), respectively, and their optimal cutoff values were 57.14% and 10.17 ng/mL, respectively. PBPC and PSA did not improve the diagnostic efficacy compared with PBPC only (P>0.05). PBPC had better power to predict EPE in patients in the non-high-risk group than in the high-risk group (P=0.03), while PSA did not differ between the two groups (P=0.14).

Conclusions

PBPC and PSA may improve the accuracy of preoperative prediction of extraprostatic extension in clinically localized prostate cancer, especially in non-high risk patients. PBPC and PSA cutoff values are useful in making surgical decisions whether to preserve neurovascular bundles (NVB) intraoperatively.

Key words: Prostate cancer, Extraprostatic extension, Risk factors, Preoperative Prediction

Jingjun Mu, Zengni Ma, Xiaoming Cao. Analysis of risk factors for extraprostatic extension in clinically localized prostate cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 326-331.

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Figures/Tables 7

References 20

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项目	数值	项目	数值
年龄(岁)	69(64~74)0.	阳性针数	006.00(3.00~10.00)
PSA(ng/ml)	17.42(8.38~30.16)	穿刺ISUP评分
前列腺体积(ml)	039.10(28.16~58.88)	1	54(24.32%)
PSAD[ng/(ml·ml)]	0.37(0.19~0.98)	2	39(17.57%)
PBPC	000041.67(21.43%~70.80%)	3	40(21.98%)
PI-RADS评分		4	39(17.57%)
≤2	16(7.21%)00	5	50(22.52%)
3	40(18.02%)0	RP后ISUP评分
4	62(27.93%)0.	1	32(14.41%)
5	104(46.85%)0.0	2	47(21.17%)
穿刺至手术间隔(d)	18(12~34)00	3	47(21.17%)
手术方式		4	38(17.12%)
腹腔镜	84(37.84%)0	5	58(26.13%)
机器人	137(61.71%)00	淋巴结清扫
开放	1(0.45%)0	未清扫	118(53.15%)
切缘		阳性	26(11.71%)
阳性	96(43.24%)0	阴性	78(35.14%)
阴性	126(56.76%)00	风险分组
pT分期		低危	22(9.91%)0
<pT₃	162(72.97%)00.	中危	61(27.48%)
≥pT₃	60(27.03%)0.	高危	139(62.61%)0

项目	数值	项目	数值
年龄(岁)	69(64~74)0.	阳性针数	006.00(3.00~10.00)
PSA(ng/ml)	17.42(8.38~30.16)	穿刺ISUP评分
前列腺体积(ml)	039.10(28.16~58.88)	1	54(24.32%)
PSAD[ng/(ml·ml)]	0.37(0.19~0.98)	2	39(17.57%)
PBPC	000041.67(21.43%~70.80%)	3	40(21.98%)
PI-RADS评分		4	39(17.57%)
≤2	16(7.21%)00	5	50(22.52%)
3	40(18.02%)0	RP后ISUP评分
4	62(27.93%)0.	1	32(14.41%)
5	104(46.85%)0.0	2	47(21.17%)
穿刺至手术间隔(d)	18(12~34)00	3	47(21.17%)
手术方式		4	38(17.12%)
腹腔镜	84(37.84%)0	5	58(26.13%)
机器人	137(61.71%)00	淋巴结清扫
开放	1(0.45%)0	未清扫	118(53.15%)
切缘		阳性	26(11.71%)
阳性	96(43.24%)0	阴性	78(35.14%)
阴性	126(56.76%)00	风险分组
pT分期		低危	22(9.91%)0
<pT₃	162(72.97%)00.	中危	61(27.48%)
≥pT₃	60(27.03%)0.	高危	139(62.61%)0

项目	OC组	EPE组	P值	项目	OC组	EPE组	P值
例数	162	60		PI-RADS评分			0.018
年龄(岁)	69(64~74)	68(64~73)	0.919	≤2	14(8.6%)0	2(3.4%)
PSA(ng/ml)	15(8~28)0	20(11~34)	0.194	3	33(20.4%)	07(11.7%)
PSA(ng/ml)	15(8~28)0	20(11~34)	0.194	4	49(30.2%)	13(21.7%)
PSAD[ng/(ml·ml)]	0.33(0.18~0.95)	0.51(0.22~1.05)0	0.1660	5	66(40.7%)	38(63.3%)
PSAD[ng/(ml·ml)]	0.33(0.18~0.95)	0.51(0.22~1.05)0	0.1660	穿刺ISUP评分			0.001
阳性针数	5(2~7)0	11(6~12).	<0.001	1	50(30.9%)	4(6.7%)
PBPC	034(15~54)0	077(49~100)	<0.0010	2	30(18.5%)	09(15.0%)
PBPC	034(15~54)0	077(49~100)	<0.0010	3	28(17.3%)	12(20.0%)
穿刺至手术间隔(d)	18(12~35)	0.17(10~33)0	0.298	4	26(16.0%)	13(21.7%)
				5	28(17.3%)	22(36.7%)
				切缘性质			<0.0010
手术方式			0.738	阳性	51(31.5%)	45(75.0%)
腹腔镜	63(38.9%)0	21(35.0%).		阴性	111(68.5%)	15(25.0%)
机器人	98(60.5%)0	39(65.0%).			0

项目	OC组	EPE组	P值	项目	OC组	EPE组	P值
例数	162	60		PI-RADS评分			0.018
年龄(岁)	69(64~74)	68(64~73)	0.919	≤2	14(8.6%)0	2(3.4%)
PSA(ng/ml)	15(8~28)0	20(11~34)	0.194	3	33(20.4%)	07(11.7%)
PSA(ng/ml)	15(8~28)0	20(11~34)	0.194	4	49(30.2%)	13(21.7%)
PSAD[ng/(ml·ml)]	0.33(0.18~0.95)	0.51(0.22~1.05)0	0.1660	5	66(40.7%)	38(63.3%)
PSAD[ng/(ml·ml)]	0.33(0.18~0.95)	0.51(0.22~1.05)0	0.1660	穿刺ISUP评分			0.001
阳性针数	5(2~7)0	11(6~12).	<0.001	1	50(30.9%)	4(6.7%)
PBPC	034(15~54)0	077(49~100)	<0.0010	2	30(18.5%)	09(15.0%)
PBPC	034(15~54)0	077(49~100)	<0.0010	3	28(17.3%)	12(20.0%)
穿刺至手术间隔(d)	18(12~35)	0.17(10~33)0	0.298	4	26(16.0%)	13(21.7%)
				5	28(17.3%)	22(36.7%)
				切缘性质			<0.0010
手术方式			0.738	阳性	51(31.5%)	45(75.0%)
腹腔镜	63(38.9%)0	21(35.0%).		阴性	111(68.5%)	15(25.0%)
机器人	98(60.5%)0	39(65.0%).			0

变量	单因素分析		P值	多因素分析		P值
变量	OR	95%CI	P值	OR	95%CI	P值
PSA	1.00	0.99~1.00	0.85	0.99	0.98~1.00	0.04
阳性针数	1.31	1.20~1.43	<0.001	0.98	0.74~1.29	0.87
PBPC	1.04	1.03~1.05	<0.001	1.04	1.00~1.08	0.04
PI-RADS评分
1	参考	参考	-	参考	参考	-
2	1.74	00.11~28.57	0.70	1.92	00.10~36.09	0.66
3	0.13	0.02~1.06	0.06	0.53	0.05~5.31	0.59
4	0.37	0.15~0.91	0.03	1.08	0.33~3.48	0.90
5	0.46	0.22~0.96	0.04	0.64	0.28~1.49	0.31
穿刺ISUP评分
1	参考	参考	-	参考	参考	-
2	0.10	0.03~0.33	<0.001	0.32	0.08~1.29	0.11
3	0.38	0.15~0.97	0.04	0.57	0.19~1.68	0.31
4	0.55	0.23~1.31	0.18	0.93	0.33~2.60	0.89
5	0.64	0.27~1.52	0.31	0.89	0.32~2.47	0.83

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