通过68Ga-PSMA正电子发射断层扫描/计算机断层扫描检测到的淋巴结寡转移前列腺癌的盆腔淋巴结清扫术

Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography.

作者信息

Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter C O, Lotz J, Schildhaus H-U, Trojan L, Sahlmann C O

机构信息

Department of Urology, University Medical Center Goettingen, Goettingen, Germany.

Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany.

出版信息

Prostate. 2015 Dec;75(16):1934-40. doi: 10.1002/pros.23091. Epub 2015 Sep 10.

DOI:10.1002/pros.23091

PMID:26356236

Abstract

BACKGROUND

The first evaluation of pelvic extended lymph node dissection (pLND) in oligometastatic prostate cancer (PCa) detected by (68)Ga-PSMA PET/CT.

METHODS

Retrospective analysis of 35 PCa patients underwent (68)Ga-PSMA PET/CT affected by biochemical recurrence (BCR) after curative treatment (n = 23) or before primary therapy of high-risk PCa (n = 12). We performed pLND associated with pathologic imaging in 17 men with nodal oligometastatic PCa.

RESULTS

Indicative lesions for PCa in PET/CT were detected in 91.4% (32 of 35) of patients. Nodal, bone, visceral (pulmonary), and within the prostate suspected disease were detected in 72% (23 of 32), 16% (5 of 32), 6% (2 of 32), and 47% (15 of 32) of patients, respectively. Median serum PSA in patients with pathological radiotracer uptake in recurrent and high-risk PCa patients was 2.9 ng/ml (range 0.18-30) and 19.5 ng/ml (range 6-90), respectively. The median number of removed lymph nodes with pLND in recurrent and high-risk PCa was 10 (range 4-17) and 12 (range 8-29) per patient and the median number of positive lymph nodes was 1 (range 1-2) and 3 (2-3) per patient, respectively. In total, two false positive and one false-negative lymph node were found. Diagnostic accuracies per nodal lesion in total of 213 removed nodes: sensitivity, 94%; specificity, 99%; positive predictive value (PPV), 89%, and negative predictive value (NPV), 99.5%. After pLND, 53% (9 of 17) of patients received androgen deprivation therapy and/or radiation therapy and hormonal therapy, while 47% (8 of 17) of patients remained free of any post-surgery therapy. Follow-up PSA remained less than 0.2 ng/ml in 82% (14 of 17) of patients. After pLND, immediate BCR (PSA never measured less than 0.2 ng/ml) in 18% (3 of 17) of patients was recorded.

CONCLUSIONS

This represents the first study of pLND in the setting of nodal oligometastatic PCa detected by (68)Ga-PSMA PET/CT. The use of (68)Ga-PSMA PET/CT could be to improve the accuracy for the detection of nodal micrometastases. These promising findings need validation in larger studies.

摘要

背景

首次对通过（68）Ga-PSMA PET/CT检测出的寡转移前列腺癌（PCa）患者进行盆腔扩大淋巴结清扫术（pLND）评估。

方法

回顾性分析35例PCa患者，其中23例为根治性治疗后发生生化复发（BCR），12例为高危PCa患者在接受初始治疗前，均接受了（68）Ga-PSMA PET/CT检查。我们对17例伴有淋巴结寡转移PCa的男性患者进行了与病理影像相关的pLND。

结果

91.4%（35例中的32例）的患者在PET/CT中检测到PCa的指示性病变。分别有72%（32例中的23例）、16%（32例中的5例）、6%（32例中的2例）和47%（32例中的15例）的患者检测到淋巴结、骨、内脏（肺）和前列腺内疑似病变。复发和高危PCa患者中，病理放射性示踪剂摄取患者的血清PSA中位数分别为2.9 ng/ml（范围0.18 - 30）和19.5 ng/ml（范围6 - 90）。复发和高危PCa患者pLND切除的淋巴结中位数分别为每位患者10个（范围4 - 17）和12个（范围8 - 29），阳性淋巴结中位数分别为每位患者1个（范围

1 - 2）和3个（2 - 3）。总共发现2例假阳性和1例假阴性淋巴结。在总共213个切除的淋巴结中，每个淋巴结病变的诊断准确性：敏感性为94%；特异性为99%；阳性预测值（PPV）为89%，阴性预测值（NPV）为99.5%。pLND后，53%（17例中的9例）的患者接受了雄激素剥夺治疗和/或放射治疗以及激素治疗，而47%（17例中的8例）的患者术后未接受任何治疗。82%（17例中的14例）的患者随访PSA仍低于0.2 ng/ml。pLND后，18%（17例中的3例）的患者记录到即刻生化复发（PSA从未测量到低于0.2 ng/ml）。