The Establishment of New Thresholds for PLND-Validated Clinical Nomograms to Predict Non-Regional Lymph Node Metastases: Using (68)Ga-PSMA PET/CT as References.
The Establishment of New Thresholds for PLND-Validated Clinical Nomograms to Predict Non-Regional Lymph Node Metastases: Using (68)Ga-PSMA PET/CT as References.
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建立经 PLND 验证的临床列线图预测非区域淋巴结转移的新阈值：使用 68Ga-PSMA PET/CT 作为参考
DOI：
10.3389/fonc.2021.658669
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发表时间：
2021
影响因子：
4.7
通讯作者：
Qin W
中科院分区：
文献类型：
--
作者：
Jiao J;Quan Z;Zhang J;Wen W;Qin J;Yang L;Meng P;Jing Y;Ma S;Wu P;Han D;Davis AA;Ren J;Yang X;Kang F;Zhang Q;Wang J;Qin W
目的盆腔淋巴结清扫术（PLND）验证的列线图被广泛接受的临床工具，通过预测盆腔淋巴结（LNM）转移来确定PLND的必要性。但是，这些列线图缺乏预测盆腔以外淋巴结转移的阈值，不适用于PLND。本研究的目的是通过使用68 Ga-PSMA PET/CT作为确定LN转移（LNM）的参考，评估可以为当前临床PLND验证的诺模图设定的阈值，以预测高危前列腺癌患者盆腔区域以外的髓外LN转移。实验设计我们对中国一家大型三级医院的57例接受68 Ga-PSMA-617 PET/CT成像的高风险初治PC患者进行了回顾性分析。通过68 Ga-PSMA-617 PET/CT检测LNM，并通过抗雄激素治疗后的成像随访进一步确定。对PC患者的LN转移扩散模式进行评估和分析。由多学科前列腺癌治疗团队基于三个临床PLND验证的列线图（Briganti，Memorial Sloan Kettering Cancer Center，Winter）评价了68 Ga-PSMA PET/CT对临床决策的影响。通过受试者工作特征（ROC）曲线分析，评价这些列线图预测肺外淋巴结转移的诊断性能和阈值。结果68 Ga-PSMA PET/CT显示49.1%的患者存在LNM，其中65.5%位于盆腔，34.5%位于眼外（52.1%位于膈上）。Briganti、MSKCC和Winter列线图显示，根据EAU和NCCN指南，本研究中70.2%-71.9%的患者需要接受ePLND。从68 Ga-PSMA PET/CT获得的LN分期信息将导致70.2%的患者改变计划管理，包括21.1%的患者改变治疗方式，这主要是由于新检测到的非局部LNM。诺模图预测非区域LNM的阈值在64%和75%之间。Briganti列线图得分>64%、MSKCC列线图得分>75%和Winter列线图得分>67%的PC患者更可能具有非区域性LNM。临床列线图（Briganti、MSKCC和Winter）预测非区域LNM的AUC（曲线下面积）分别为0.816、0.830和0.793。结论以68 Ga-PSMA PET/CT作为LNM的参考，PLND验证的临床列线图不仅可以预测局部LNM，还可以预测非局部LNM。来自68 Ga-PSMA PET/CT的额外信息可以为超过三分之二的患者提供基于诺模图的临床决策，以减少不必要的PLND。我们的重点是，可以设置一个阈值，目前临床PLND验证诺模图预测的肺外LN转移的AUC准确性约80%，优化后的简单诺模图，这可能有助于提高效率，PC治疗显着的临床实践。
Purpose PLND (pelvic lymph node dissection)-validated nomograms are widely accepted clinical tools to determine the necessity of PLND by predicting the metastasis of lymph nodes (LNMs) in pelvic region. However, these nomograms are in lacking of a threshold to predict the metastasis of extrareolar lymph nodes beyond pelvic region, which is not suitable for PLND. The aim of this study is to evaluate a threshold can be set for current clinical PLND-validated nomograms to predict extrareolar LN metastases beyond pelvic region in high-risk prostate cancer patients, by using 68Ga-PSMA PET/CT as a reference to determine LN metastases (LNMs). Experimental Design We performed a retrospective analysis of 57 high-risk treatment-naïve PC patients in a large tertiary care hospital in China who underwent 68Ga-PSMA-617 PET/CT imaging. LNMs was detected by 68Ga-PSMA-617 PET/CT and further determined by imaging follow-up after anti-androgen therapy. The pattern of LN metastatic spread of PC patients were evaluated and analyzed. The impact of 68Ga-PSMA PET/CT on clinical decisions based on three clinical PLND-validated nomograms (Briganti, Memorial Sloan Kettering Cancer Center, Winter) were evaluated by a multidisciplinary prostate cancer therapy team. The diagnostic performance and the threshold of these nomograms in predicting extrareolar LNMs metastasis were evaluated via receiver operating characteristic (ROC) curve analysis. Results LNMs were observed in 49.1% of the patients by 68Ga-PSMA PET/CT, among which 65.5% of LNMs were pelvic-regional and 34.5% of LNMs were observed in extrareolar sites (52.1% of these were located above the diaphragm). The Briganti, MSKCC and Winter nomograms showed that 70.2%-71.9% of the patients in this study need to receive ePLND according to the EAU and NCCN guidelines. The LN staging information obtained from 68Ga-PSMA PET/CT would have led to changes of planned management in 70.2% of these patients, including therapy modality changes in 21.1% of the patients, which were mainly due to newly detected non-regional LNMs. The thresholds of nomograms to predict non-regional LNMs were between 64% and 75%. The PC patients with a score >64% in Briganti nomogram, a score >75% in MSKCC nomogram and a score >67% in Winter nomogram were more likely to have non-regional LNMs. The AUCs (Area under curves) of the clinical nomograms (Briganti, MSKCC and Winter) in predicting non-regional LNMs were 0.816, 0.830 and 0.793, respectively. Conclusions By using 68Ga-PSMA PET/CT as reference of LNM, the PLND-validated clinical nomograms can not only predict regional LNMs, but also predict non-regional LNMs. The additional information from 68Ga-PSMA PET/CT may provide added benefit to nomograms-based clinical decision-making in more than two-thirds of patients for reducing unnecessary PLND. We focused on that a threshold can be set for current clinical PLND-validated nomograms to predict extrareolar LN metastases with an AUC accuracy of about 80% after optimizing the simple nomograms which may help to improve the efficiency for PC therapy significantly in clinical practice.
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影响因子：
158.5
作者：
Harisinghani, MG;Barentsz, J;Weissleder, R
通讯作者：
Weissleder, R
DOI：
10.1007/s00259-019-04568-1
发表时间：
2019-12-04
影响因子：
9.1
作者：
Ferraro, Daniela A.;Schueler, Helena I. Garcia;Burger, Irene A.
通讯作者：
Burger, Irene A.
DOI：
10.1007/s00259-017-3670-z
发表时间：
2017-06-01
影响因子：
9.1
作者：
Fendler, Wolfgang P.;Eiber, Matthias;Herrmann, Ken
通讯作者：
Herrmann, Ken
影响因子：
23.4
作者：
Mottet, Nicolas;Bellmunt, Joaquim;Cornford, Philip
通讯作者：
Cornford, Philip
影响因子：
9.3
作者：
Koerber, Stefan A.;Stach, Gerald;Giesel, Frederik L.
通讯作者：
Giesel, Frederik L.