基于MRI的淋巴结影像报告和数据系统（Node-RADS）在评估肾细胞癌区域淋巴结转移中的诊断和预后价值
Diagnostic and prognostic value of MRI-based Node-RADS for the assessment of regional lymph node metastasis in renal cell carcinoma.
作者信息
Bai Xu, Peng Cheng, Liu Baichuan, Zhou Shaopeng, Liu Haili, Chen Yijian, Guo Huiping, Hao Yuwei, Liu Xin, Zhao Jian, Ding Xiaohui, Li Lin, Zhang Xu, Ye Huiyi, Ma Xin, Wang Haiyi
机构信息
Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing 100853, China; Department of Radiology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100039, China.
Department of Urology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing 100853, China.
出版信息
Diagn Interv Imaging. 2025 Apr;106(4):117-125. doi: 10.1016/j.diii.2024.10.005. Epub 2024 Oct 29.
PURPOSE
The purpose of this study was to assess the capabilities of MRI-based Node Reporting and Data System (Node-RADS) in diagnosing regional lymph node metastasis (RLNM) and to estimate its prognostic significance in patients with renal cell carcinomas (RCCs).
MATERIALS AND METHODS
Patients with RCC who underwent nephrectomy and regional lymph node dissection between January 2010 and August 2023 were retrospectively included. Two senior radiologists scored lymph nodes in consensus using MRI-based Node-RADS. The performance of MRI-based Node-RADS for the diagnosis of RLNM was estimated using area under receiver operating characteristic (AUC) curves and compared against size criteria. Three additional readers scored all lesions to assess interobserver agreement. Progression-free survival and overall survival were estimated and compared between patients with low (1-3) and high (4-5) scores.
RESULTS
Overall, 216 patients with RCC were enrolled, including 58 with RLNM. There were 157 men and 59 women with a median age of 54 years (range: 8-83 years). Node-RADS showed larger AUC (0.93 [95 % confidence interval (CI): 0.87-0.97]) and higher specificity (96.8 % [95 % CI: 92.8-99.0]) compared to size criteria (0.88 [95 % CI: 0.83-0.94] and 87.3 % [95 % CI: 81.1-92.1], respectively) for the diagnosis of RLNM (P = 0.039 and P < 0.001, respectively). Substantial interobserver agreement in Node-RADS scoring was obtained between the three readers (weighted κ, 0.75 [95 % CI: 0.69-0.80]). During a median follow-up of 56 months, patients with high Node-RADS score experienced poorer progression-free survival (P < 0.001) and overall survival (P < 0.001) than those with low Node-RADS score. At multivariable Cox regression analysis, Node-RADS was an independent variable associated with RCC prognosis after adjustment for confounders.
CONCLUSIONS
The MRI-based Node-RADS demonstrates notable performance in detecting RLNM and showed potential prognostic significance for RCCs.
目的
本研究旨在评估基于磁共振成像（MRI）的淋巴结报告与数据系统（Node-RADS）在诊断区域淋巴结转移（RLNM）方面的能力，并评估其在肾细胞癌（RCC）患者中的预后意义。
材料与方法
回顾性纳入2010年1月至2023年8月期间接受肾切除术和区域淋巴结清扫术的RCC患者。两名资深放射科医生使用基于MRI的Node-RADS对淋巴结进行一致评分。使用受试者操作特征（AUC）曲线下面积评估基于MRI的Node-RADS对RLNM的诊断性能，并与大小标准进行比较。另外三名阅片者对所有病变进行评分以评估观察者间的一致性。估计并比较低评分（1-3分）和高评分（4-5分）患者的无进展生存期和总生存期。
结果
总体而言，纳入了216例RCC患者，其中58例有RLNM。有157名男性和59名女性，中位年龄为54岁（范围：8-83岁）。与大小标准相比，Node-RADS在诊断RLNM时显示出更大的AUC（0.93[95%置信区间（CI）：0.87-0.97]）和更高的特异性（96.8%[95%CI：92.8-99.0]）（大小标准的AUC为0.88[95%CI：0.83-0.94]，特异性为87.3%[95%CI：81.1-92.1]）（P分别为0.039和P<0.001）。三名阅片者在Node-RADS评分中获得了较高的观察者间一致性（加权κ值，0.75[95%CI：0.69-0.80]）。在中位随访56个月期间，高Node-RADS评分的患者比低Node-RADS评分的患者无进展生存期（P<0.001）和总生存期（P<0.001）更差。在多变量Cox回归分析中，调整混杂因素后，Node-RADS是与RCC预后相关的独立变量。
结论
基于MRI的Node-RADS在检测RLNM方面表现出显著性能，并对RCC显示出潜在的预后意义。
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