第一部分 术前 PI-RADS 评估对前列腺癌根治术后患者病理结果的影响

目的：探索术前标准化前列腺影像报告和数据系统（PI-RADS）评估的磁共振成像（MRI）结果对接受前列腺根治性切除术（RP）的前列腺癌（PCa）患者的病理结果的影响。

患者和方法：本研究是一项回顾性队列研究，纳入了 2017 年 1 月至 2022 年 12 月期间在我院接受前列腺动态增强 MRI 和随后 RP 治疗 PCa 的患者。根据术前 MRI的评估方案，患者被分为 PI-RADS 组和非 PI-RADS 组。研究回顾并分析了患者的术前特征和术后结果，包括病理 T 分期（pT2 与 pT3–4）和阳性手术切缘（PSMs）。根据术前显著变量对患者进行进一步分层，以评估病理结果的差异，并进行了基于上述术前特征的倾向评分匹配。

结果：本研究共纳入 380 例患者，其中 PI-RADS 组 201 例，非 PI-RADS 组 179 例。两组的术前特征相似，除了临床 T 分期（cT）。在病理结果方面，PI-RADS 组的 pT3–4 比例显著较低（21.4% vs. 48.0%，p < 0.001），PSMs 比例较低（31.3% vs. 40.9%，p = 0.055），且 cT 与 pT 的一致性更高（79.1% vs. 64.8%，p = 0.003）。在 cT1-2 亚组和倾向评分匹配后的队列中，PI-RADS 组的 pT3–4 比例也较低（p < 0.001）。在cT3 患者中，PI-RADS 组的 PSMs 比例降低了 39.2%，但无统计学意义（p = 0.089）。

结论：术前 MRI 结合标准化 PI-RADS 评估可以通过降低 RP 后病理证实的非局限性 PCa 的比例并略微降低 PSMs 比例，为患者的临床决策提供帮助。

The first part: Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy.

Objective: To assess the effect of preoperative MRI with standardized Prostate Imaging–Reporting and Data System (PI -RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP).

Patients and methods: This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3–4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed.

Results: A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3 – 4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3 – 4 (p < 0.001) in the cT1 – 2subgroup and the cohort after propensity score matching. The PSMs rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p =0.089).

Conclusions: Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSMs rate compared with non-PI-RADS assessment.