Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
J Nucl Med. 2021 Oct;62(10):1363-1371. doi: 10.2967/jnumed.120.259788. Epub 2021 Feb 5.
Despite good sensitivity and a good negative predictive value, the implementation of sentinel node biopsy (SNB) in robot-assisted radical prostatectomy with extended pelvic lymph node dissection (ePLND) for prostate cancer is still controversial. For this reason, we aimed to define the added value of SNB (with different tracer modalities) to ePLND in the identification of nodal metastases. Complication rates and oncologic outcomes were also assessed. From January 2006 to December 2019, prospectively collected data were retrospectively analyzed from a single-institution database regarding prostate cancer patients treated with robot-assisted radical prostatectomy and ePLND with or without additional use of SNB, either with the hybrid tracer indocyanine green (ICG)-Tc-nanocolloid or with free ICG. Multivariable logistic and Cox regression models tested the impact of adding SNB (either with the hybrid tracer or with free ICG) on lymph nodal invasion detection, complications, and oncologic outcomes. Overall, 1,680 patients were included in the final analysis: 1,168 (69.5%) in the non-SNB group, 161 (9.6%) in the ICG-SNB group, and 351 (20.9%) in the hybrid-SNB group. The hybrid-SNB group (odds ratio, 1.61; 95%CI, 1.18-2.20; = 0.002) was an independent predictor of nodal involvement, whereas the ICG-SNB group did not reach independent predictor status when compared with the non-SNB group (odds ratio, 1.35; 95%CI, 0.89-2.03; = 0.1). SNB techniques were not associated with higher rates of complications. Lastly, use of hybrid SNB was associated with lower rates of biochemical recurrence (0.79; 95%CI, 0.63-0.98) and of clinical recurrence (hazard ratio, 0.76, = 0.035) than were seen in the non-SNB group. The implementation of hybrid-SNB technique with ICG-Tc-nanocolloid in prostate cancer improves detection of positive nodes and potentially lowers recurrence rates with subsequent optimization of patient management, without harming patient safety.
尽管前哨淋巴结活检 (SNB) 具有良好的敏感性和阴性预测值，但在机器人辅助根治性前列腺切除术联合广泛盆腔淋巴结清扫术 (ePLND) 中实施 SNB 对于前列腺癌仍存在争议。因此，我们旨在确定 SNB（使用不同示踪剂）在识别淋巴结转移方面对 ePLND 的附加价值。还评估了并发症发生率和肿瘤学结果。
从 2006 年 1 月至 2019 年 12 月，我们从一个单机构数据库中回顾性地分析了前瞻性收集的数据，该数据库涉及接受机器人辅助根治性前列腺切除术和 ePLND 治疗的前列腺癌患者，这些患者要么单独使用 ePLND，要么联合使用 SNB，示踪剂为混合吲哚菁绿（ICG）-Tc-纳米胶体或游离 ICG。多变量逻辑和 Cox 回归模型测试了添加 SNB（使用混合示踪剂或游离 ICG）对淋巴结侵犯检测、并发症和肿瘤学结果的影响。
总体而言，1680 例患者被纳入最终分析：非 SNB 组 1168 例（69.5%），ICG-SNB 组 161 例（9.6%），混合 SNB 组 351 例（20.9%）。混合 SNB 组（比值比，1.61；95%CI，1.18-2.20； = 0.002）是淋巴结受累的独立预测因素，而与非 SNB 组相比，ICG-SNB 组未达到独立预测因素地位（比值比，1.35；95%CI，0.89-2.03； = 0.1）。SNB 技术与更高的并发症发生率无关。最后，与非 SNB 组相比，混合 SNB 的使用与较低的生化复发率（0.79；95%CI，0.63-0.98）和临床复发率（风险比，0.76， = 0.035）相关。
在前列腺癌中实施 ICG-Tc-纳米胶体混合 SNB 技术可提高阳性淋巴结的检出率，并有可能降低复发率，从而优化患者管理，同时不损害患者安全。
