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Preoperative MRI-based estimation of risk for positive resection margin after radical prostatectomy in patients with prostate cancer: development and validation of a simple scoring system

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Abstract

Objectives

To develop a simplified MRI-based model to predict the risk for positive surgical margins (PSMs) after radical prostatectomy (RP) in patients with prostate cancer (PCa).

Methods

Consecutive patients who underwent RP for PCa were retrospectively identified from a tertiary referral hospital. Patients who underwent RP between January 2014 and June 2014 were assigned as derivation cohort (n = 330) and those between January 2018 and February 2018 were assigned as validation cohort (n = 100). MRI-based predictors associated with PSM were assessed: tumor size, tumor-capsule contact length, the Prostate Imaging Reporting and Data System (PI-RADS) category, tumor location (tumor contact to the apex or posterolateral side near the neurovascular bundle), apical depth, and prostate volume. A prediction model was developed by using multivariable logistic regression, and then it was transformed into a scoring system. The prediction and calibration performance of this scoring system was evaluated using the C statistics and Hosmer-Lemeshow goodness-of-fit test.

Results

A total of 121 (36.7%) and 32 (32.0%) of patients in the derivation and validation cohorts had PSMs after RP. The scoring system consisted of the following variables: tumor-capsule contact length, PI-RADS category, tumor located at the apex and/or posterolateral side. This scoring system provided good prediction performance for PSM in the derivation (C statistics, 0.80 [95% CI: 0.76, 0.85]) and validation (C statistics, 0.77 [95% CI: 0.68, 0.87]) cohorts, and also showed good calibration in both cohorts (p = 0.83 and 0.86, respectively).

Conclusions

An MRI-based scoring system can help estimate the risk of PSM after RP.

Key Points

• An MRI-based scoring system served as a tool to estimate the risk of positive surgical margin (C statistics, 0.80 and 0.77 in the derivation and validation cohorts, respectively) after radical prostatectomy.

• Tumor with contact to the apex or posterolateral aspect, the tumor contact length to capsule, and higher PI-RADS category were independent predictors for the presence of positive resection margins after radical prostatectomy in men with prostate cancer.

• High-risk patients as determined by the scoring system demonstrated adverse post-surgical outcomes compared with low- or intermediate-risk patients, in regard to longer length (mean length, 13.0 mm versus 3.9 mm in low risk or 6.2 mm in intermediate risk; p ≤ 0.001) and higher Gleason grade at the margin (grades 4 and 5 in 69.4% and 20.4% versus 16.7% and 16.7% in low risk or 46.7% and 5.4% in intermediate risk; p < 0.001).

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Abbreviations

ADC:

Apparent diffusion coefficient

DWI:

Diffusion-weighted image

EPE:

Extraprostatic extension

mpMRI:

Multiparametric magnetic resonance imaging

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

Prostate-specific antigen

PSM:

Positive surgical margin

RP:

Radical prostatectomy

TCL:

Tumor-capsule contact length

T2WI:

T2-weighted image

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Acknowledgments

We thank Seo Young Park for her assistance with statistical analysis which improved the manuscript.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Mi Yeon Park, Kye Jin Park, Mi-hyun Kim & Jeong Kon Kim

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  1. Mi Yeon Park
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Corresponding author

Correspondence to Kye Jin Park.

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Guarantor

The scientific guarantor of this publication is Jeong Kon Kim, M.D., Ph.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Seo Young Park, the statistician of Asan Medical Center, kindly provided statistical advice for this manuscript.

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The requirement for written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• Retrospective

• Diagnostic performance study

• Performed at a single institution

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Park, M.Y., Park, K.J., Kim, Mh. et al. Preoperative MRI-based estimation of risk for positive resection margin after radical prostatectomy in patients with prostate cancer: development and validation of a simple scoring system. Eur Radiol 31, 4898–4907 (2021). https://doi.org/10.1007/s00330-020-07569-z

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