Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Prostate. 2022 Sep;82(12):1210-1218. doi: 10.1002/pros.24376. Epub 2022 Jun 2.
The numbers needed to image to identify pelvic lymph node and/or distant metastases in newly diagnosed prostate cancer (PCa) patients according to risk level are unknown.
Relying on Surveillance, Epidemiology, and End Results (2010-2016), we tabulated rates and proportions of patients with (a) lymph node or (b) distant metastases according to National Comprehensive Cancer Network (NCCN) risk level and calculated the number needed to image (NNI) for both endpoints. Multivariable logistic regression analyses were performed.
Of 145,939 newly diagnosed PCa patients assessable for analyses of pelvic lymph node metastases (cN1), 4559 (3.1%) harbored cN1 stage: 13 (0.02%), 18 (0.08%), 63 (0.3%), 512 (2.8%), and 3954 (14.9%) in low, intermediate favorable, intermediate unfavorable, high, and very high-risk levels. These resulted in NNI of 4619, 1182, 319, 35, and 7, respectively. Of 181,109 newly diagnosed PCa patients assessable for analyses of distant metastases (M1 ), 8920 (4.9%) harbored M1 stage: 50 (0.07%), 45 (0.1%), 161 (0.5%), 1290 (5.1%), and 7374 (22.0%) in low, intermediate favorable, intermediate unfavorable, high, and very high-risk. These resulted in NNI of 1347, 602, 174, 20, and 5, respectively.
Our observations perfectly validated the NCCN recommendations for imaging in newly diagnosed high and very high-risk PCa patients. However, in unfavorable intermediate-risk PCa patients, in whom bone and soft tissue imaging is recommended, the NNI might be somewhat elevated to support routine imaging in clinical practice.
根据风险水平，在新诊断的前列腺癌 (PCa) 患者中，需要进行多少影像学检查才能识别盆腔淋巴结和/或远处转移尚不清楚。
依靠监测、流行病学和最终结果 (2010-2016)，我们根据国家综合癌症网络 (NCCN) 风险水平列出了有 (a) 淋巴结或 (b) 远处转移的患者的比例和比例，并计算了这两个终点的影像学检查次数 (NNI)。进行了多变量逻辑回归分析。
在可评估盆腔淋巴结转移 (cN1) 的 145939 例新诊断的 PCa 患者中，有 4559 例 (3.1%) 存在 cN1 期：低危、中危有利、中危不利、高危和极高危水平分别为 13 例 (0.02%)、18 例 (0.08%)、63 例 (0.3%)、512 例 (2.8%) 和 3954 例 (14.9%)。这导致 NNI 分别为 4619、1182、319、35 和 7。在可评估远处转移 (M1) 的 181109 例新诊断的 PCa 患者中，有 8920 例 (4.9%) 存在 M1 期：低危、中危有利、中危不利、高危和极高危水平分别为 50 例 (0.07%)、45 例 (0.1%)、161 例 (0.5%)、1290 例 (5.1%) 和 7374 例 (22.0%)。这导致 NNI 分别为 1347、602、174、20 和 5。
我们的观察结果完全验证了 NCCN 对新诊断的高危和极高危 PCa 患者进行影像学检查的建议。然而，在不利的中危风险 PCa 患者中，建议进行骨骼和软组织成像，因此在临床实践中可能需要稍微增加 NNI 以支持常规成像。
