Pretreatment MRI as a Prognostic Factor After Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Although some clinical and pathological parameters are established prognostic factors, the role of imaging parameters in prognostication is unclear.

尽管一些临床和病理参数是已确立的预后因素，但影像参数在预后判断中的作用尚不明确。

Background

To assess the prognostic value of pretreatment magnetic resonance imaging (MRI) parameters for oncological outcomes in men undergoing radical prostatectomy.

评估术前磁共振成像(MRI)参数对接受根治性前列腺切除术男性的肿瘤学结果的预后价值。

data_sources_and_study_selection

A systematic literature search of MEDLINE, Embase, and Scopus was performed from inception through March 2025.

从建库开始至2025年3月，对MEDLINE、Embase和Scopus进行了系统的文献检索。

Studies were included if they evaluated pretreatment prostate MRI in men undergoing radical prostatectomy and reported multivariable, time-to-event analyses for the outcomes of biochemical recurrence, metastatic failure, and prostate cancer-specific mortality.

如果研究评估了接受根治性前列腺切除术男性的术前前列腺MRI，并报告了多变量、时间至事件分析结果，包括生化复发、转移失败和前列腺癌特异性死亡率，则被纳入研究。

data_extraction_and_synthesis

Two reviewers independently extracted data and assessed study quality using the Quality in Prognostic Studies tool.

两位评审员独立提取数据并使用预后研究质量工具评估研究质量。

Random-effects meta-analysiswas performed to pool hazard ratios (HRs).

进行了随机效应的荟萃分析以合并风险比（HRs）。

main_outcomes_and_measures

The primary outcome was biochemical recurrence.

主要结果是生化复发。

Secondary outcomes included metastatic failure and prostate cancer-specific mortality.

次要结果包括转移性失败和前列腺癌特异性死亡。

Results

Forty studies were included (comprising 24 941 patients).

纳入了40项研究（共24 941名患者）。

Extraprostatic extension (mrT3a disease) detected with MRI was independently associated with biochemical recurrence (pooled HR, 2.16 [95% CI, 1.84-2.54]), metastatic failure (HR, 3.18 [95% CI, 2.04-4.97]), and prostate cancer-specific mortality (HR, 10.93 [95% CI, 5.05-23.65]).

MRI检测到的前列腺外扩展（mrT3a疾病）与生化复发（汇总HR，2.16 [95% CI, 1.84-2.54]）、转移失败（HR，3.18 [95% CI, 2.04-4.97]）和前列腺癌特异性死亡（HR，10.93 [95% CI, 5.05-23.65]）独立相关。

Seminal vesicle invasion (mrT3b disease) detected with MRI was also independently associated with biochemical recurrence (HR, 2.74 [95% CI, 2.06-3.65]) and metastatic failure (HR, 5.58 [95% CI, 1.15-27.13]).

MRI检测到的精囊侵犯（mrT3b疾病）也与生化复发（HR，2.74 [95% CI, 2.06-3.65]）和转移失败（HR，5.58 [95% CI, 1.15-27.13]）独立相关。

The following quantitative MRI features were prognostic for biochemical recurrence: Prostate Imaging Reporting and Data System score of 4 or 5 (HR, 2.15 [95% CI, 1.82-2.55]), large tumor size (tumor diameter ≥20 mm; HR, 2.35 [95% CI, 1.71-3.24]), and apparent diffusion coefficient values less than 0.9 × 10-3 mm2/s (HR, 2.39 [95% CI, 1.82-3.14]).

以下定量MRI特征对生化复发具有预后意义：前列腺成像报告和数据系统评分为4或5（HR，2.15 [95% CI, 1.82-2.55]），大肿瘤体积（肿瘤直径≥20毫米；HR，2.35 [95% CI, 1.71-3.24]），以及表观扩散系数小于0.9 × 10^-3 mm^2/s（HR，2.39 [95% CI, 1.82-3.14]）。

Heterogeneity was moderate (I2 < 65% for mrT3a and mrT3b disease) and no significant publication bias was detected.

异质性为中等（mrT3a和mrT3b疾病的I2 < 65%），未检测到显著的出版偏倚。

conclusions_and_relevance

This systematic reviewand meta-analysisfound that pretreatment MRI provides independent prognostic value for biochemical recurrence, metastatic failure, and prostate cancer-specific mortality in men undergoing radical prostatectomy, even when adjusted for established clinicopathologic factors.

这项系统评价和荟萃分析发现，即使在调整了已建立的临床病理因素后，术前MRI对于接受根治性前列腺切除术的男性在生化复发、转移失败和前列腺癌特异性死亡方面提供了独立的预后价值。