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Abstract
Purpose: This study aimed to develop a model for predicting pathologic extracapsular extension (ECE) and seminal vesicle invasion (SVI) while integrating magnetic resonance imaging-based T-staging (cTMRI, cT1c-cT3b).

Materials and methods: A total of 1,915 who underwent radical prostatectomy between 2006-2016 met the inclusion/exclusion criteria. We performed a multivariate logistic regression analysis as well as Bayesian network (BN) modeling based on possible confounding factors. The BN model was internally validated using 5-fold validation.

Results: According to the multivariate logistic regression analysis, initial prostate-specific antigen (iPSA) (β=0.050, p < 0.001), percentage of positive biopsy cores (PPC) (β=0.033, p < 0.001), both lobe involvement on biopsy (β=0.359, p=0.009), Gleason score (β=0.358, p < 0.001), and cTMRI (β=0.259, p < 0.001) were significant factors for ECE. For SVI, iPSA (β=0.037, p < 0.001), PPC (β=0.024, p < 0.001), Gleason score (β=0.753, p < 0.001), and cTMRI (β=0.507, p < 0.001) showed statistical significance. BN models to predict ECE and SVI were also successfully established. The overall area under the receiver operating characteristic curve (AUC)/accuracy of the BN models were 0.76/73.0% and 0.88/89.6% for ECE and SVI, respectively. According to internal comparison between the BN model and Roach formula, BN model had improved AUC values for predicting ECE (0.76 vs. 0.74, p=0.060) and SVI (0.88 vs. 0.84, p < 0.001).

Conclusion: Two models to predict pathologic ECE and SVI integrating cTMRI were established and installed on a separate website for public access to guide radiation oncologists.

Affiliations

Chan Woo Wee  1   2 , Bum-Sup Jang  3 , Jin Ho Kim  2   4   5 , Chang Wook Jeong  6 , Cheol Kwak  6 , Hyun Hoe Kim  6 , Ja Hyeon Ku  6 , Seung Hyup Kim  7 , Jeong Yeon Cho  7 , Sang Youn Kim  7
1 Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea.
2 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.
4 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
5 Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
6 Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
7 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.