External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer

Xu, Lili; Zhang, Gumuyang; Zhang, Xiaoxiao; Bai, Xin; Yan, Weigang; Xiao, Yu; Sun, Hao; Jin, Zhengyu

doi:10.3389/fonc.2021.655093

Cited by 10 publications

(13 citation statements)

References 29 publications

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“…Subsequently, some scholars conducted external verification on the prediction of pathological EPE by EPE grade. Among them, Xu et al [ 13 ] conducted external validation of EPE grade results, showing that EPE grade has high accuracy in predicting pathological EPE, and the sensitivity is significantly improved (sensitivity 0.767-0.778). There is a meta-analysis of EPE grade predicting pathological EPE [ 14 ], which included 4 studies and 1294 patients, and results showed that the EPE grade system showed high sensitivity (82%) and medium specificity (63%), with an AUC of 0.82 (95% CI 0.79–0.85).…”

Section: Discussionmentioning

confidence: 99%

MRI Extraprostatic Extension Grade: Accuracy and Clinical Incremental Value in the Assessment of Extraprostatic Cancer

Xiang

Huang

et al. 2022

BioMed Research International

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Objective. The purpose was to compare the accuracy of extraprostatic extension (EPE) grade on MRI predicting EPE with Partin tables, Memorial Sloan Kettering Cancer Center nomogram (MSKCCn), and combined models and to analyze the clinical incremental value of EPE grade. Materials and Methods. 105 prostate cancer patients confirmed by pathology after radical prostatectomy in our hospital from 2017 to 2021 were selected. The clinical stage, PSA, Gleason score, number of positive biopsy cores, and percentage of positive biopsy cores were recorded. Evaluate EPE grade according to EPE grade criteria, and calculate the probability of predicting EPE with Partin tables and MSKCCn. EPE grade is combined with Partin tables and MSKCCn to construct EPE grade+Partin tables and EPE grade+MSKCCn models. Calculate the area under the curve (AUC), sensitivity, and specificity of EPE grade, Partin tables, MSKCCn, EPE grade+Partin tables, and EPE grade+MSKCCn and compare their diagnostic efficacy. The clinical decision curve was used to analyze the clinical net income of each prediction scheme. Results. The AUC of EPE grade was 0.79, Partin tables was 0.50, MSKCCn was 0.78, the EPE grade+Partin table model was 0.79, and the EPE grade+MSKCCn model was 0.83. After EPE grade was combined with Partin tables and MSKCCn, the diagnostic efficiency of clinical model was significantly improved ( P < 0.05 ). There was no significant difference in the diagnostic efficacy of the combined model compared with the single EPE grade ( P > 0.05 ). The calibration curve of the combined model shows that it has a good calibration degree for EPE. In the analysis of the decision curve, the net income of the EPE grade is higher than that of Partin tables and MSKCCn and is equal to the EPE grade+Partin tables and is slightly lower than that of EPE grade+MSKCCn. The clinical net income of the combined model is obviously higher than that of individual clinical models. Conclusion. The accuracy of EPE classification in predicting prostate cancer EPE is high, and combined with the clinical model, it can significantly improve the diagnostic efficiency of the clinical model and increase the clinical benefit.

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Section: Discussionmentioning

confidence: 99%

MRI Extraprostatic Extension Grade: Accuracy and Clinical Incremental Value in the Assessment of Extraprostatic Cancer

Xiang

Huang

et al. 2022

BioMed Research International

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“…A total of 29 studies were excluded due to insufficient data to reconstruct 2 × 2 tables, not in the field of interest, and could not reproduce the sensitivity and specificity. Consequently, a total of 4 studies comprising 1,294 participants were included in the present meta-analysis (18,(25)(26)(27).…”

Section: Literature Search and Data Extractionmentioning

confidence: 99%

“…In all studies, the MRI images were interpreted by 2 radiologists independently with experience of 2-15 years. The inter-reader agreement calculated with kappa values was reported by 3 studies, which ranged from 0.47 to 0.88 (25)(26)(27). In 1 study, the MRI was performed with a 1.5-T scanner (25), whereas all the remaining 3 studies used 3.0-T scanners.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Generally, quality assessment for included studies was high (Figure 2). However, concerning the patient selection domain, 3 of 4 studies were retrospective in study design (25)(26)(27). For the index test domain, one study reported that the radiologists were aware that patients were diagnosed with PCa and had undergone RP but were unaware of the final histopathologic finding (26).…”

Section: Quality Assessmentmentioning

confidence: 99%

“…The EPE grade showed substantial inter-reader agreement and good diagnostic performance, and association with histopathologic tumor extension. the EPE grading system, and less experienced radiologists could benefit from this guideline and yield good diagnostic accuracy (26,27). Nonetheless, the EPE grading system is still burdened with a subjective bias between radiologists due to some qualitative analyses (25).…”

Section: Xumentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Performance of Extraprostatic Extension Grading System for Detection of Extraprostatic Extension in Prostate Cancer: A Diagnostic Systematic Review and Meta-Analysis

Shang

et al. 2022

Front. Oncol.

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PurposeTo evaluate the diagnostic performance of the extraprostatic extension (EPE) grading system for detection of EPE in patients with prostate cancer (PCa).Materials and MethodsWe performed a literature search of Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar to identify eligible articles published before August 31, 2021, with no language restrictions applied. We included studies using the EPE grading system for the prediction of EPE, with histopathological results as the reference standard. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) were calculated with the bivariate model. Quality assessment of included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsA total of 4 studies with 1,294 patients were included in the current systematic review. The pooled sensitivity and specificity were 0.82 (95% CI 0.76–0.87) and 0.63 (95% CI 0.51–0.73), with the area under the hierarchical summary receiver operating characteristic (HSROC) curve of 0.82 (95% CI 0.79–0.85). The pooled LR+, LR−, and DOR were 2.20 (95% CI 1.70–2.86), 0.28 (95% CI 0.22–0.36), and 7.77 (95% CI 5.27–11.44), respectively. Quality assessment for included studies was high, and Deeks’s funnel plot indicated that the possibility of publication bias was low (p = 0.64).ConclusionThe EPE grading system demonstrated high sensitivity and moderate specificity, with a good inter-reader agreement. However, this scoring system needs more studies to be validated in clinical practice.

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Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

Jiang

Liang

et al. 2023

Cancer Medicine

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BackgroundAccurate assessment of the clinical staging is crucial for determining the need for radical prostatectomy (RP) in prostate cancer (PCa). However, the current methods for PCa staging may yield incorrect results. This study aimed to comprehensively analyze independent predictors of postoperative upstaging of intraprostatic cancer.MethodsWe conducted a retrospective analysis of data from intraprostatic cancer patients who underwent radical surgery between March 2019 and December 2022. Intraprostatic cancer was defined as a lesion confined to the prostate, excluding cases where multiparameter magnetic resonance imaging (mpMRI) showed the lesion in contact with the prostatic capsule. We assessed independent predictors of extraprostatic extension (EPE) and analyzed their association with positive surgical margin (PSM) status. In addition, based on the distance of the lesion from the capsule on mpMRI, we divided the patients into non‐transition zone and transition zone groups for further analysis.ResultsA total of 500 patients were included in our study. Logistic regression analysis revealed that biopsy Gleason grade group (GG) (odds ratio, OR: 1.370, 95% confidence interval, CI: 1.093–1.718) and perineural invasion (PNI) (OR: 2.746, 95% CI: 1.420–5.309) were predictive factors for postoperative EPE. Both biopsy GG and PNI were associated with lateral (GG: OR: 1.270, 95% CI: 1.074–1.501; PNI: OR: 2.733, 95% CI: 1.521–4.911) and basal (GG: OR: 1.491, 95% CI: 1.194–1.862; PNI: OR: 3.730, 95% CI: 1.929–7.214) PSM but not with apex PSM (GG: OR: 1.176, 95% CI: 0.989–1.399; PNI: OR: 1.204, 95% CI: 0.609–2.381) after RP. Finally, PNI was an independent predictor of EPE in the transition zone (OR: 11.235, 95% CI: 2.779–45.428) but not in the non‐transition zone (OR: 1.942, 95% CI: 0.920–4.098).ConclusionPNI and higher GG may indicate upstaging of tumors in patients with intraprostatic carcinoma. These two factors are associated with PSM in locations other than the apex of the prostate. Importantly, cancer in the transition zone of the prostate is more likely to spread externally through nerve invasion than cancer in the non‐transition zone.

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External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer

Cited by 10 publications

References 29 publications

MRI Extraprostatic Extension Grade: Accuracy and Clinical Incremental Value in the Assessment of Extraprostatic Cancer

MRI Extraprostatic Extension Grade: Accuracy and Clinical Incremental Value in the Assessment of Extraprostatic Cancer

Diagnostic Performance of Extraprostatic Extension Grading System for Detection of Extraprostatic Extension in Prostate Cancer: A Diagnostic Systematic Review and Meta-Analysis

Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

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