Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China.
Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Asian J Androl. 2021 Jul-Aug;23(4):409-414. doi: 10.4103/aja.aja_89_20.
Accurate methods for identifying pelvic lymph node metastasis (LNM) of prostate cancer (PCa) prior to surgery are still lacking. We aimed to investigate the predictive value of peripheral monocyte count (PMC) for LNM of PCa in this study. Two hundred and ninety-eight patients from three centers were divided into a training set (n = 125) and a validation set (n = 173). In the training set, the independent predictors of LNM were analyzed using univariate and multivariate logistic regression analyses, and the optimal cutoff value was calculated by the receiver operating characteristic (ROC) curve. The sensitivity and specificity of the optimal cutoff were authenticated in the validation cohort. Finally, a nomogram based on the PMC was constructed for predicting LNM. Multivariate analyses of the training cohort demonstrated that clinical T stage, preoperative Gleason score, and PMC were independent risk factors for LNM. The subsequent ROC analysis showed that the optimal cutoff value of PMC for diagnosing LNM was 0.405 × 109 l with a sensitivity of 60.0% and a specificity of 67.8%. In the validation set, the optimal cutoff value showed significantly higher sensitivity than that of conventional magnetic resonance imaging (MRI) (0.619 vs 0.238, P < 0.001). The nomogram involving PMC, free prostate-specific antigen (fPSA), clinical T stage, preoperative Gleason score, and monocyte-to-lymphocyte ratio (MLR) was generated, which showed a robust predictive capacity for predicting LNM before the operation. Our results indicated that PMC as a single agent, or combined with other clinical parameters, showed a robust predictive capacity for LNM in PCa. It can be employed as a complementary factor for the decision of whether to conduct pelvic lymph node dissection.
在手术前准确识别前列腺癌（PCa）盆腔淋巴结转移（LNM）的方法仍然缺乏。本研究旨在探讨外周血单核细胞计数（PMC）对 PCa 淋巴结转移的预测价值。来自三个中心的 298 名患者被分为训练集（n=125）和验证集（n=173）。在训练集中，使用单因素和多因素逻辑回归分析来分析 LNM 的独立预测因素，并通过接受者操作特征（ROC）曲线计算最佳截断值。在验证队列中验证最佳截断值的敏感性和特异性。最后，基于 PMC 构建了预测 LNM 的列线图。训练队列的多因素分析表明，临床 T 分期、术前 Gleason 评分和 PMC 是 LNM 的独立危险因素。随后的 ROC 分析表明，PMC 诊断 LNM 的最佳截断值为 0.405×109 l，敏感性为 60.0%，特异性为 67.8%。在验证集中，最佳截断值的敏感性显著高于传统磁共振成像（MRI）（0.619 比 0.238，P<0.001）。涉及 PMC、游离前列腺特异性抗原（fPSA）、临床 T 分期、术前 Gleason 评分和单核细胞/淋巴细胞比值（MLR）的列线图具有良好的预测 LNM 能力。我们的研究结果表明，PMC 作为单一指标或与其他临床参数联合，对预测 PCa 的 LNM 具有良好的预测能力。它可以作为是否进行盆腔淋巴结清扫的决策的补充因素。
