Department of Urology, Oregon Health and Science University, Portland, OR, USA.
Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
Clin Genitourin Cancer. 2022 Dec;20(6):e490-e497. doi: 10.1016/j.clgc.2022.05.003. Epub 2022 May 7.
Radionuclide imaging will change the role of computed tomography and magnetic resonance imaging (CT/MRI) for prostate cancer (CaP) staging. Current guidelines recommend abdominopelvic imaging for new cases of CaP categorized as unfavorable intermediate risk (UIR) or higher. We assessed the performance characteristics of CT/MRI based on the National Comprehensive Cancer Network (NCCN) guidelines and developed a model that predicts cN1 disease using conventional imaging.
We selected patients in the National Cancer Database diagnosed with CaP from 2010 to 2016 with available age, prostate specific antigen, clinical locoregional staging, biopsy Gleason grading, and core information. Multivariate logistic regression (MLR) was used on a undersampled training dataset using cN1 as the outcome. Performance characteristics were compared to those of the three most recent versions of the NCCN guidelines.
A total of 443,640 men were included, and 2.5% had cN1 disease. Using CT/MRI only, the current NCCN guidelines have a sensitivity of 99%, and the number needed to image (NNI) is 24. At the same sensitivity, the cN1 risk was 1.6% using the MLR. The NNI for UIR alone is 341. Using the MLR model and a threshold of 10%, the PPV is 10.3% and 64% of CTs/MRIs could be saved at a cost of missing 6% of cN1 patients (or 0.15% of all patients).
The NCCN guidelines are sensitive for detecting cN1 with CT/MRI, however, the number needed to image is 24. Obtaining CT/MRI for nodal staging when patients have a cN1 risk of 10% would reduce total imaging while still remaining sensitive. As novel PET tracers becomes increasingly used for initial CaP staging, well calibrated prediction models trained on the outcome of interest should be developed as decision aids for obtaining imaging.
放射性核素成像将改变计算机断层扫描和磁共振成像（CT/MRI）在前列腺癌（CaP）分期中的作用。目前的指南建议对新诊断为不利中危（UIR）或更高风险的 CaP 病例进行腹盆腔成像。我们评估了基于国家综合癌症网络（NCCN）指南的 CT/MRI 的性能特征，并开发了一种使用常规成像预测 cN1 疾病的模型。
我们从 2010 年至 2016 年在国家癌症数据库中选择了有年龄、前列腺特异性抗原、临床局部区域分期、活检 Gleason 分级和核心信息的 CaP 患者。使用多元逻辑回归（MLR）对一个抽样不足的训练数据集进行分析，以 cN1 为结果。性能特征与 NCCN 指南的三个最新版本进行了比较。
共纳入 443640 名男性，2.5%患有 cN1 疾病。仅使用 CT/MRI，目前的 NCCN 指南的敏感度为 99%，需要成像的数量（NNI）为 24。在相同的敏感度下，使用 MLR 的 cN1 风险为 1.6%。仅 UIR 的 NNI 为 341。使用 MLR 模型和阈值为 10%，PPV 为 10.3%，可以节省 64%的 CTs/MRIs，代价是漏诊 6%的 cN1 患者（或所有患者的 0.15%）。
NCCN 指南对 CT/MRI 检测 cN1 具有较高的敏感性，然而，需要成像的数量为 24。当患者的 cN1 风险为 10%时，为进行淋巴结分期获得 CT/MRI 可以减少总成像数量，同时保持敏感性。随着新型 PET 示踪剂越来越多地用于初始 CaP 分期，应针对感兴趣的结果开发经过良好校准的预测模型，作为获取影像学检查的决策辅助工具。
