四种验证后的列线图（纪念斯隆凯特琳癌症中心、布里甘蒂2012年、2017年和2019年）预测高危前列腺癌患者行根治性前列腺切除术及扩大盆腔淋巴结清扫术后淋巴结侵犯情况的比较：临床经验及文献综述
Comparison of Four Validated Nomograms (Memorial Sloan Kettering Cancer Center, Briganti 2012, 2017, and 2019) Predicting Lymph Node Invasion in Patients with High-Risk Prostate Cancer Candidates for Radical Prostatectomy and Extended Pelvic Lymph Node Dissection: Clinical Experience and Review of the Literature.
作者信息
Di Pierro Giovanni Battista, Salciccia Stefano, Frisenda Marco, Tufano Antonio, Sciarra Alessandro, Scarrone Emiliano, Del Giudice Francesco, Asero Vincenzo, Bevilacqua Giulio, Moriconi Martina, Carbone Antonio, Pastore Antonio, Signore Stefano, Bove Pierluigi, Forte Flavio, Emiliozzi Paolo, Tubaro Andrea, De Nunzio Cosimo, Canale Vittorio
机构信息
Department ''Materno Infantile e Scienze Urologiche'', Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy.
Department of Urology, ICOT Latina, University Sapienza, 04100 Latina, Italy.
出版信息
Cancers (Basel). 2023 Mar 9;15(6):1683. doi: 10.3390/cancers15061683.
BACKGROUND
The indication for extended pelvic lymph node dissection (ePLND) at the time of radical prostatectomy (RP) is based on nomograms predicting the risk of lymph node invasion (LNI). However, limited data are available on the comparison of these predictive models in high-risk prostate cancer (PC) patients. Therefore, we compared the accuracy of the most used nomograms (MSKCC, Briganti 2012, 2017, and 2019) in the setting of high-risk PC patients submitted to ePLND.
METHODS
150 patients with high-risk PC disease treated from 2019 to 2022 were included. Before RP + ePLND, we assessed the MSKCC, Briganti 2012, 2017, and 2019 nomograms for each patient, and we compared the prediction of LNI with the final histopathological analysis of the ePLND using pathologic results as a reference.
RESULTS
LNI was found in 39 patients (26%), and 71.3% were cT2. The percentage of patients with estimated LNI risk above the cut-off was significantly higher in pN+ cases than in pN0 for all Briganti nomograms. The percentage of patients at risk of LNI, according to Briganti Nomogram (2012, 2017, and 2019), was significantly higher in pN+ cases than in pN0 ( < 0.04), while MSKCC prediction didn't vary significantly between pN0 and pN+ groups ( = 0.2). All nomograms showed high sensitivity (Se > 0.90), low specificity (Sp < 0.20), and similar AUC (range: 0.526-0.573) in predicting pN+. Particularly, 74% of cases patients with MSKCC estimated risk > 7% showed pN0 compared to 71% with Briganti 2012 > 5%, 69% with Briganti 2017 > 7%, and 70% with Briganti 2019 > 7%.
CONCLUSIONS
Despite the high-risk disease, in our patients treated with ePLND emerges a still high number of pN0 cases and a similar low specificity of nomograms in predicting LNI.
背景
根治性前列腺切除术（RP）时扩大盆腔淋巴结清扫术（ePLND）的指征基于预测淋巴结转移（LNI）风险的列线图。然而，关于这些预测模型在高危前列腺癌（PC）患者中的比较数据有限。因此，我们比较了在接受ePLND的高危PC患者中最常用列线图（MSKCC、Briganti 2012、2017和2019）的准确性。
方法
纳入2019年至2022年治疗的150例高危PC疾病患者。在RP + ePLND之前，我们评估了每位患者的MSKCC、Briganti 2012、2017和2019列线图，并将LNI的预测结果与ePLND的最终组织病理学分析结果进行比较，以病理结果作为参考。
结果
39例患者（26%）发现有LNI，71.3%为cT2期。对于所有Briganti列线图，pN+病例中估计LNI风险高于临界值的患者百分比显著高于pN0病例。根据Briganti列线图（2012、2017和2019），pN+病例中有LNI风险的患者百分比显著高于pN0病例（P < 0.04），而MSKCC预测在pN0和pN+组之间没有显著差异（P = 0.2）。所有列线图在预测pN+时均显示出高敏感性（Se > 0.90）、低特异性（Sp < 0.20）和相似的AUC（范围：0.526 - 0.573）。特别是，MSKCC估计风险> 7%的病例中，74%显示为pN0，而Briganti 2012> 5%的为71%，Briganti 2017> 7%的为69%，Briganti 2019> 7%的为70%。
结论
尽管疾病为高危，但在我们接受ePLND治疗的患者中，仍有相当数量的pN0病例，且列线图在预测LNI方面的特异性同样较低。
Zotero 插件