Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
Eur Urol Oncol. 2020 Feb;3(1):73-79. doi: 10.1016/j.euo.2019.09.004. Epub 2019 Oct 5.
Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown.
To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC.
DESIGN, SETTING, AND PARTICIPANTS: Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded.
FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT.
We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation.
FDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS.
In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.
淋巴结转移（LNM）的存在是上尿路上皮癌（UTUC）患者癌症特异性生存（CSS）的重要预后因素。在各种肿瘤中，氟代脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（FDG-PET/CT）是一种用于术前淋巴结（LN）分期的既定方法。在 UTUC 中，FDG-PET/CT 对 LN 分期的诊断价值尚不清楚。
确定 FDG-PET/CT 在 UTUC 患者 LN 分期中的诊断价值。
设计、地点和参与者：回顾性收集了 2007 年至 2017 年间在 8 个中心接受 FDG-PET/CT 检查后行手术治疗的 152 例 UTUC 患者的数据。排除接受新辅助化疗的患者。
FDG-PET/CT 结果与淋巴结清扫（LND）后的组织病理学结果进行比较。使用 Kaplan-Meier 估计分析无复发生存率（RFS）、CSS 和总生存率（OS），并比较 FDG-PET/CT 有可疑 LN 与无可疑 LN 的患者。
我们纳入了 117 例患者，其中 62 例行 LND。17 例患者在组织病理学评估中存在 LNM。FDG-PET/CT 对 LNM 的诊断灵敏度和特异性分别为 82%（95%置信区间[CI]：57-96）和 84%（95% CI：71-94）。FDG-PET/CT 检查 LN 阳性的患者 RFS 明显较差（p=0.03）。CSS（p=0.11）和 OS（p=0.5）在两组间无差异。本研究受到回顾性设计和样本量的限制。我们的结果需要进一步验证。
FDG-PET/CT 对 UTUC 患者 LNM 的检测灵敏度为 82%，特异性为 84%。FDG-PET/CT 上可疑 LN 的存在与较差的 RFS 相关。
在上尿路上皮癌患者中，正电子发射断层扫描与计算机断层扫描（PET/CT）扫描可以以相当高的准确性检测淋巴结转移。氟代脱氧葡萄糖 PET/CT 上可疑淋巴结的存在与无复发生存率较差相关。
