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Published on: September 3, 2013
MRI-detected extranodal extension as a marker of prostate cancer aggressiveness
Aline Araújo Naves1, Gabriel de Lion Gouvea1, Camila V B Machado1
1Department of Imaging, Oncology and Hematology, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Objective:
Extranodal extension (ENE) is a histological marker of aggressiveness for various cancers. We evaluated if clinical ENE, detected by Magnetic Resonance Imaging, can also serve as a biological marker of Prostate Cancer (PCa) aggressiveness.
Materials And Methods:
This retrospective, single-center study analyzed patients diagnosed with PCa and had MRI on a 3-T scanner from January 2013 to December 2017. After exclusions, 461 patients were included and divided into: Group 1, no lymph node involvement (LNI), Group 2 (LNI without ENE), and Group 3 (LNI and ENE). Two experienced radiologists assessed the MRI scans for primary lesion characteristics, LNI and ENE. Reproducibility assessment was calculated for ENE and PI-RADS. Clinical outcomes, including Overall Survival (OS), Specific Survival Rate (SSR), and Progression-Free Survival (PFS), were analyzed.
Results:
Group 1 included 410 patients, Group 2, 32 patients, and Group 3, 19 patients. The prevalence of ENE was 4.1%. Significant differences between groups were observed for age, PSA, dPSA, ISUP scores, clinical risk stratification, and staging (all p < 0.01). The Kappa coefficient for ENE was 0.75 (95% CI: 0.56-0.90), and 0.48 (0.14-1.0) for PI-RADS. Cox proportional hazards model showed PSA (HR: 1.009; 95% CI = 1.003-1.015, p < 0.01) and ENE (HR: 8.50; 1.76-40.98, p < 0.01) were associated with SSR, and both ENE (HR: 8.18; 2.34-28.58, p < 0.01) and LNI (HR: 5.99, 1.97-18.17, p < 0.01) were linked to poor PFS.
Conclusion:
MRI-detected ENE, despite low prevalence, is a predictor of SSR and PFS in PCa. These findings support ENE as an independent prognostic marker. Further prospective, multi-institutional studies are required to validate these results.
Key Points:
Question Pathological extranodal extension (pENE) has been described as a marker of worrisome prognosis in prostate cancer (PCa), but clinical ENE has not been evaluated as a marker of prognosis in PCa. Findings MRI-detected clinical ENE, had a low prevalence in our cohort (4.1%), but it was a predictor of specific survival rate and progression-free survival. Clinical relevance MRI-detected clinical ENE, a reproducible imaging feature, may serve as a non-invasive biomarker for aggressive prostate cancer. It correlates with poorer progression-free survival and specific survival rates, offering valuable prognostic insights for patient management.
Insights
Magnetic Resonance Imaging (MRI)-detected extranodal extension (ENE) in prostate cancer (PCa) predicts survival outcomes. This imaging marker, despite its low prevalence, offers valuable prognostic insights for aggressive PCa.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Extranodal extension (ENE) is a known histological marker of aggressiveness in various cancers.
- The prognostic value of clinically detected ENE in prostate cancer (PCa) using Magnetic Resonance Imaging (MRI) has not been established.
Purpose of the Study:
- To evaluate if clinically detected ENE on MRI can serve as a biological marker of PCa aggressiveness.
- To assess the association of MRI-detected ENE with clinical outcomes such as Overall Survival (OS), Specific Survival Rate (SSR), and Progression-Free Survival (PFS).
Main Methods:
- A retrospective analysis of 461 PCa patients who underwent MRI on a 3-T scanner between 2013 and 2017.
- Patients were categorized based on lymph node involvement (LNI) and ENE presence.
- Two radiologists assessed MRI scans for lesion characteristics, LNI, and ENE, with reproducibility assessed for ENE and PI-RADS.
Main Results:
- The prevalence of MRI-detected ENE was 4.1%.
- Significant differences in age, PSA, ISUP scores, and staging were observed between groups.
- Cox proportional hazards models indicated that ENE was significantly associated with both SSR (HR: 8.50) and PFS (HR: 8.18), while LNI was linked to poor PFS (HR: 5.99).
Conclusions:
- MRI-detected ENE is a reproducible imaging feature that serves as an independent prognostic marker for PCa.
- Despite its low prevalence, clinical ENE detected by MRI predicts Specific Survival Rate and Progression-Free Survival.
- These findings support the use of MRI-detected ENE as a non-invasive biomarker for identifying aggressive prostate cancer.
