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External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for
Lili Xu1, Gumuyang Zhang1, Xiaoxiao Zhang1
1Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Objectives:
To externally validate the extraprostatic extension (EPE) grade criteria on MRI and analyze the incremental value of EPE grade to clinical models of prostate cancer.
Methods:
A consecutive 130 patients who underwent preoperative prostate MRI followed by radical prostatectomy between January 2015 to January 2020 in our institution were retrospectively enrolled. The EPE grade, Cancer of the Prostate Risk Assessment (CAPRA), and Memorial Sloan Kettering Cancer Center nomogram (MSKCCn) score for each patient were assigned. Significant clinicopathological factors in univariate and multivariate analyses were combined with EPE grade to build the Clinical + EPE grade model, and the CAPRA and MSKCCn score were also combined with EPE grade to build the CAPRA + EPE grade and MSKCCn + EPE grade model, respectively. The area under the curve (AUC), sensitivity and specificity of these models were calculated to evaluate their diagnostic performance. Calibration and decision curve analyses were used to analyze their calibration performance and clinical utility.
Results:
The AUC for predicting EPE was 0.767-0.778 for EPE grade, 0.704 for CAPRA, and 0.723 for MSKCCn. After combination with EPE grade, the AUCs of these clinical models increased significantly than using clinical models along (P < 0.05), but was comparable with using EPE grade alone (P > 0.05). The calibration curves of EPE grade, clinical models and combined models showed that these models are well-calibrated for EPE. In the decision curve analysis, EPE grade showed slightly higher net benefit than MSKCCn and CAPRA.
Conclusion:
The EPE grade showed good performance for evaluating EPE in our cohort and possessed well clinical utility. Further combinations with the EPE grade could improve the diagnostic performance of clinical models.
Insights
Extraprostatic extension (EPE) grade on MRI shows good performance for predicting EPE and improves prostate cancer clinical models. Combining EPE grade with existing models enhances diagnostic accuracy for better patient outcomes.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Extraprostatic extension (EPE) is a critical prognostic factor in prostate cancer.
- Accurate preoperative assessment of EPE is essential for treatment planning and predicting outcomes.
Purpose of the Study:
- To externally validate the MRI-based extraprostatic extension (EPE) grade criteria.
- To assess the incremental value of EPE grade when added to established clinical models for prostate cancer.
Main Methods:
- Retrospective analysis of 130 patients who underwent preoperative prostate MRI and radical prostatectomy.
- Assignment of EPE grade, Cancer of the Prostate Risk Assessment (CAPRA), and Memorial Sloan Kettering Cancer Center nomogram (MSKCCn) scores.
- Development of combined models (Clinical + EPE grade, CAPRA + EPE grade, MSKCCn + EPE grade) and evaluation of diagnostic performance using AUC, calibration, and decision curve analysis.
Main Results:
- EPE grade demonstrated strong predictive performance for EPE (AUC 0.767-0.778).
- Combined models incorporating EPE grade showed significantly improved AUC compared to clinical models alone.
- EPE grade exhibited comparable performance to EPE grade alone and showed slightly higher net benefit than MSKCCn and CAPRA in decision curve analysis.
Conclusions:
- The EPE grade criteria on MRI are validated and show good performance and clinical utility for evaluating EPE.
- Incorporating EPE grade into existing clinical models enhances their diagnostic performance for prostate cancer.
- EPE grade serves as a valuable tool for improving preoperative risk stratification and treatment decisions.
