Abstract
PurposeTo investigate the diagnostic performance of using quantitative assessment with multiparametric MRI (mpMRI) for prediction of extraprostatic extension (EPE) in patients with prostate cancer (PCa).MethodsWe performed a computerized search of MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar from inception until July 31, 2021. Summary estimates of sensitivity and specificity were pooled with the bivariate model, and quality assessment of included studies was performed with the Quality Assessment of Diagnostic Accuracy Studies-2. We plotted forest plots to graphically present the results. Multiple subgroup analyses and meta-regression were performed to explore the variate clinical settings and heterogeneity.ResultsA total of 23 studies with 3,931 participants were included. The pooled sensitivity and specificity for length of capsular contact (LCC) were 0.79 (95% CI 0.75–0.83) and 0.77 (95% CI 0.73–0.80), for apparent diffusion coefficient (ADC) were 0.71 (95% CI 0.50–0.86) and 0.71 (95% CI 059–0.81), for tumor size were 0.62 (95% CI 0.57–0.67) and 0.75 (95% CI 0.67–0.82), and for tumor volume were 0.77 (95% CI 0.68–0.84) and 0.72 (95% CI 0.56–0.83), respectively. Substantial heterogeneity was presented among included studies, and meta-regression showed that publication year (≤2017 vs. >2017) was the significant factor in studies using LCC as the quantitative assessment (P=0.02).ConclusionFour quantitative assessments of LCC, ADC, tumor size, and tumor volume showed moderate to high diagnostic performance of predicting EPE. However, the optimal cutoff threshold varied widely among studies and needs further investigation to establish.
Highlights
Extraprostatic extension (T3a and T3b) in PCa is associated with a higher risk of biochemical recurrence and metastatic disease after radical prostatectomy (RP) or radiotherapy [1, 2]
The primary outcome was the diagnostic performance of using mpMRI quantitative metrics of LCC, ADC, tumor size, and tumor volume as independent predictors for prediction of EPE in PCa
The search terms combined acronyms used for MRI, PCa, EPE, and quantitative assessments as follows: ([MR] or [MRI] or [mpMRI] or [magnetic resonance] or [magnetic resonance imaging]) and ([prostate cancer] or [PCa] or [prostate carcinoma]) and ([EPE] or [extraprostatic extension] or [ECE] or [extracapsular extension]) and ([tumor size] or [tumor volume] or [tumor dimension] or [ADC] or [apparent diffusion coefficient] or [LCC] or [TCL] or [length of tumor capsular contact] or [capsule contact length] or [tumor contact length])
Summary
Extraprostatic extension (T3a and T3b) in PCa is associated with a higher risk of biochemical recurrence and metastatic disease after radical prostatectomy (RP) or radiotherapy [1, 2]. Comprehensive risk assessment and staging is of great importance, which will influence the treatment planning and management To overcome this problem, various nomograms and guidelines were proposed to improve the preoperative risk evaluation, including Partin tables, Memorial Sloan Kettering Cancer Center nomograms, and the cancer of the prostate risk assessment score [6,7,8]. Various nomograms and guidelines were proposed to improve the preoperative risk evaluation, including Partin tables, Memorial Sloan Kettering Cancer Center nomograms, and the cancer of the prostate risk assessment score [6,7,8] These well-established measures are roughly correlated with the final pathologic stage and lacking accuracy in clinical practice [9, 10]
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