预测前列腺癌的微小转移灶（<1cm）至盆腔淋巴结：术前 MRI 的作用。

Prediction of Micrometastasis (< 1 cm) to Pelvic Lymph Nodes in Prostate Cancer: Role of Preoperative MRI.

机构信息

1 Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.

2 Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

AJR Am J Roentgenol. 2015 Sep;205(3):W328-34. doi: 10.2214/AJR.14.14138.

DOI:10.2214/AJR.14.14138

PMID:26295669

Abstract

OBJECTIVE

The purpose of this study was to retrospectively investigate whether preoperative MRI plays a key role in clinical prediction of micrometastasis (< 1 cm) to pelvic lymph nodes in prostate cancer.

MATERIALS AND METHODS

One hundred one patients with prostate cancer who underwent preoperative MRI and radical prostatectomy with pelvic lymph node dissection were included. None of the patients had a pelvic lymph node with a short-axis diameter of 1 cm or larger on MRI. Both clinical (prostate-specific antigen, biopsy Gleason score, greatest percentage of biopsy core, and percentage of positive cores) and MRI parameters (tumor apparent diffusion coefficient and tumor staging) were assessed. The univariate, multivariate, and ROC curve analyses were conducted.

RESULTS

Of 101 patients, nine (8.9%) had pelvic lymph node metastases. In univariate analysis, all of the clinical and MRI parameters were related to micrometastasis to pelvic lymph nodes (p < 0.05). However, multivariate analysis revealed that only preoperative MRI stage was significant (p = 0.044). AUC of preoperative MRI stage was 0.954 (odds ratio, 21.7). Respective sensitivity and specificity of preoperative tumor staging by MRI were 100% and 65.2% with cutoff of T3a or more, and 88.9% and 94.6% with cutoff of T3b for predicting micrometastasis to pelvic lymph nodes.

CONCLUSION

Preoperative MRI staging may play a role in prediction of micrometastasis (< 1 cm) to pelvic lymph nodes in prostate cancer.

摘要

目的

本研究旨在回顾性分析术前 MRI 检查在预测前列腺癌微小转移（<1cm）至盆腔淋巴结中的作用。

材料与方法

共纳入 101 例行术前 MRI 检查及盆腔淋巴结清扫术的前列腺癌患者。所有患者的 MRI 检查均未发现直径>1cm 的盆腔淋巴结。评估了临床（前列腺特异抗原、活检 Gleason 评分、活检核心最大百分比和阳性核心百分比）和 MRI 参数（肿瘤表观扩散系数和肿瘤分期）。进行了单因素、多因素和 ROC 曲线分析。

结果

101 例患者中，9 例（8.9%）发生盆腔淋巴结转移。单因素分析显示，所有临床和 MRI 参数均与盆腔淋巴结微小转移相关（p<0.05）。然而，多因素分析显示，只有术前 MRI 分期有统计学意义（p=0.044）。术前 MRI 分期的 AUC 为 0.954（优势比为 21.7）。MRI 术前肿瘤分期的敏感度和特异度分别为 100%和 65.2%，截断值为 T3a 或更高，88.9%和 94.6%，截断值为 T3b，用于预测盆腔淋巴结的微小转移。