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1.
Giorgio Gandaglia Guillaume Ploussard Massimo Valerio Agostino Mattei Cristian Fiori Nicola Fossati Armando Stabile Jean-Baptiste Beauval Bernard Malavaud Mathieu Roumiguié Daniele Robesti Paolo Dell’Oglio Marco Moschini Stefania Zamboni Arnas Rakauskas Francesco De Cobelli Francesco Porpiglia Francesco Montorsi Alberto Briganti 《European urology》2019,75(3):506-514
Background
Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies.Objective
To assess the accuracy of available tools to predict LNI and to develop a novel model for men diagnosed via MRI-targeted biopsies.Design, setting, and participants
A total of 497 patients diagnosed via MRI-targeted biopsies and treated with RP and extended pelvic lymph node dissection (ePLND) at five institutions were retrospectively identified.Outcome measurements and statistical analyses
Three available models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analyses. A nomogram predicting LNI was developed and internally validated.Results and limitations
Overall, 62 patients (12.5%) had LNI. The median number of nodes removed was 15. The AUC for the Briganti 2012, Briganti 2017, and MSKCC nomograms was 82%, 82%, and 81%, respectively, and their calibration characteristics were suboptimal. A model including PSA, clinical stage and maximum diameter of the index lesion on multiparametric MRI (mpMRI), grade group on targeted biopsy, and the presence of clinically significant PCa on concomitant systematic biopsy had an AUC of 86% and represented the basis for a coefficient-based nomogram. This tool exhibited a higher AUC and higher net benefit compared to available models developed using standard biopsies. Using a cutoff of 7%, 244 ePLNDs (57%) would be spared and a lower number of LNIs would be missed compared to available nomograms (1.6% vs 4.6% vs 4.5% vs 4.2% for the new nomogram vs Briganti 2012 vs Briganti 2017 vs MSKCC).Conclusions
Available models predicting LNI are characterized by suboptimal accuracy and clinical net benefit for patients diagnosed via MRI-targeted biopsies. A novel nomogram including mpMRI and MRI-targeted biopsy data should be used to identify candidates for ePLND in this setting.Patient summary
We developed the first nomogram to predict lymph node invasion (LNI) in prostate cancer patients diagnosed via magnetic resonance imaging-targeted biopsy undergoing radical prostatectomy. Adoption of this model to identify candidates for extended pelvic lymph node dissection could avoid up to 60% of these procedures at the cost of missing only 1.6% patients with LNI. 相似文献2.
Clinical parameters that predict histology of postchemotherapy retroperitoneal lymph node mass in testicular cancer 总被引:2,自引:0,他引:2
MIZUKI ONOZAWA KOJI KAWAI TAKAHIRO YAMAMOTO SHIRO HINOTSU SADAMU TSUKAMOTO KAZUNORI HATTORI NAOTO MIYANAGA TORU SHIMAZUI HIDEYUKI AKAZA 《International journal of urology》2004,11(7):535-541
BACKGROUND: Since the advent of cisplatin-based chemotherapy, the majority of metastatic testicular cancers can be cured by chemotherapy followed by retroperitoneal lymph node dissection (RPLND). However, postchemotherapy RPLND confers no therapeutic benefit if the residual mass contains no viable cells. Therefore, to determine which parameters predict a patient's likelihood of having only necrosis in the residual mass, we retrospectively analyzed clinical parameters of patients who underwent postchemotherapy RPLND. METHODS: Data from 27 patients with metastatic testicular cancer were analyzed. The histology of the primary tumor was seminoma in 11 cases and non-seminoma in 16 cases. All of the patients with non-seminoma showed a normalization of tumor markers after chemotherapy. Analysis of clinical parameters included data for the initial histology, pretreatment tumor marker levels, postchemotherapy retroperitoneal mass size, and the histology of the dissected RPLNs. RESULTS: Histological examination of dissected RPLNs showed residual tumor in 27% of seminoma patients and 38% of non-seminoma patients. In seminoma patients, no viable cells were found in all six patients with pretreatment lactate dehydrogenase (LDH) levels below 7.5 times the upper limit of normal, or in all five of the patients with postchemotherapy RPLNs less than 2.5 cm. In non-seminoma patients, no viable cells were found in nine of 10 patients with pretreatment alpha-fetoprotein (AFP) levels less than 2700 ng/mL, or in eight of nine patients with residual mass less than 2.5 cm. CONCLUSIONS: Both postchemotherapy RPLN mass size and pretreatment tumor marker levels are possible predictors for necrosis of the residual mass in testicular cancer patients. 相似文献
3.
18F-FDG PET/CT对非小细胞肺癌区域淋巴结诊断的假阴性与假阳性研究 总被引:1,自引:1,他引:0
目的探讨18^F-FDG PET/CT在检测非小细胞肺癌(NSCLC)区域淋巴结中出现假阴性和假阳性的因素。方法随机选择手术治疗的NSCLC患者48例,术前1周内行18^F—FDG PET/CT检查,同期行CT增强扫描,术后根据病理检查结果分析PET/CT诊断NSCLC区域淋巴结转移的假阴性与假阳性因素。结果48例患者共切除区域淋巴结313枚,转移淋巴结51枚,PET/CT结果7枚假阴性。8枚假阳性,阳性预测值和阴性预测值分别为85%,97%,高于CT(57%,94%;P=0.002,0.045)。3枚假阴性淋巴结内的癌灶较小;2枚淋巴结短径约为0.4mm,小于PET/CT的空间分辨率;2枚紧邻原发灶的淋巴结,图像无法区分而视为原发灶。8枚假阳性淋巴结为患者在原发病灶基础上并发不同程度的肺部疾病和淋巴结炎症,使其糖代谢率增高。结论假阳性出于(1)淋巴结的短径小于PET/CT的空间分辨率;(2)淋巴结内的小癌灶糖代谢率较低;(3)紧邻原发灶的淋巴结与原发灶无法区分。原发肿瘤合并肺部疾病是导致PET/CT出现假阳性的重要原因。 相似文献
4.
逆转录-聚合酶链反应检测胃癌淋巴结微转移 总被引:1,自引:0,他引:1
目的 检测胃癌常规病理检查阴性的淋巴结微转移的发生及与其它临床参考指标的关系。方法 利用逆转录-聚合酶链反应(RT-PCR)方法检测68枚胃癌胃周淋巴结癌胚抗原(CEA)mRNA基因表达,同时比较RT-PCR与免疫组化(IHC)方法的检测敏感性。结果 CEAmRNA RT-PCR是一种很敏感的方法,可以检测1/10^6个转移的癌细胞;检测19例胃癌患者取材的68枚胃周淋巴结,IHC阳性率28%(19/68),RT-PCR阳性率57%(39-68),两组之间差异有非常显著性意义(P<0.01);RT-PCR阳性率与胃部临床参考指标密切相关,且随着病期进展而增大。结论 CEA mRNA RT-PCR是比免疫组化更敏感的方法,可以预测胃癌淋巴结微转移,能够有效地避免已有微小转移的患者被漏诊。 相似文献
5.
Yutaka Yonemura Masataka Segawa Hisashi Matsumoto Kouichirou Tsugawa Itasu Ninomiya Luis Fonseca Takashi Fujimura Kazuo Sugiyama Kouichi Miwa Itsuo Miyazaki 《Surgery today》1994,24(6):488-493
Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach. 相似文献
6.
为给临床心脏术后监测心淋巴管损伤程度及可能出现的并发症提供参考指标,以手术方法阻断羊心淋巴流并对其血清相关成份进行了测定。实验发现,实验组术后谷草转氨酶(SGOT)、谷丙转氨酶(SGPT)、碱性磷酸酶(AKP)、乳酸脱氢酶(LDH)均有不同程度的增高,以SGOT增高最为明显,术前均值为47.53U,术后2天增至104.20U,高峰出现时间最早,多在术后24小时。血清离子改变中低钾最为突出,血钾在术后2天明显降低(P<0.01),术后7天逐渐恢复,术后14天恢复至术前水平。血清蛋白改变以球蛋白降低、白蛋白/球蛋白比值升高为主。提示心淋巴循环郁滞可导致心肌细胞损伤、毛细血管通透性和结构的改变。不同酶活性的变化对郁滞的敏感度存在着差异。 相似文献
7.
Luca Oscar Redaelli De Zinis Andrea Bolzoni Cesare Piazza Piero Nicolai 《European archives of oto-rhino-laryngology》2006,263(12):1131-1135
Lymph node (LN) metastases represent the most important negative prognostic factor in squamous cell carcinoma (SCC) of the oral cavity, even though controversies still exist regarding their management. The aim of this study was to retrospectively analyze our experience in surgical management of SCC of the oral cavity with particular focus on the prevalence and localization of lymph nodal metastases and recurrences. The clinical records of 89 consecutive patients treated from 1983 to 2002 by concomitant surgery on both the T and N sites, excluding those undergoing salvage surgery, were reviewed. A total of 119 neck dissections (ND) were performed. Survival outcomes were calculated by the Kaplan–Meier method, while univariate comparisons by the log-rank and non-parametric tests were performed between different groups of patients. Five-year overall and determinate survivals were 50 and 57%, respectively. LN metastases were observed in 52% (56% of these showing extracapsular spread) and their presence strongly correlated with determinate survival (p < 0.0001). The prevalence of clinical and occult nodal disease was not related to the pT status. Neck levels II (59%) and I (56%) were most frequently involved. Metastases to level IV accounted for 15% of positive LN, even though 28% of them turned out to be skip metastases. Five neck recurrences were observed, only one of which was salvaged by surgery. The high prevalence of clinical and occult LN metastases in this setting suggests that ND should be performed on a nearly routine basis, even for lesions with a low-T category and a cN0 neck. Moreover, ND should always encompass level IV due to the possibility of skip metastases, particularly in tumors involving the oral tongue. In patients with a cN+ neck, levels from I to V should be addressed, particularly in the presence of metastases at levels III and IV. 相似文献
8.
高频灰阶超声鉴别良恶性胸肌淋巴结 总被引:1,自引:0,他引:1
目的:评价灰阶超声在鉴别良、恶性胸肌淋巴结中的应用价值.材料和方法:研究对象为43枚乳癌患者的胸肌淋巴结,其中16枚为转移性胸肌淋巴结、27枚为非转移性胸肌淋巴结;另有19枚乳腺良性病变患者的胸肌淋巴结和22枚正常者的胸肌淋巴结作为对照组.使用仪器为HDI-3000型彩色多普勒超声诊断仪,配备5~12MHz宽频控头.运用超声测量胸肌淋巴结的长径、轮廓形态、长径-厚度比、髓皮质厚度比,作为鉴别良、恶性胸肌淋巴结的参数,比较良、恶性胸肌淋巴结在形态学上差异.结果:良、恶性胸肌淋巴结的长径、轮廓形态、髓皮质厚度比无显著性差异;恶性淋巴结长径-厚度比(1.7±0.4)明显低于良性淋巴结(2.0±0.5),P<0.05.结论:灰阶超声在鉴别良、恶性胸肌淋巴结中具有一定的应用价值. 相似文献
9.
本文采用S-100蛋白为免疫学标记,对34例恶性肿瘤局部淋巴结内树突状细胞进行免疫组化定量研究。结果按S-100蛋白阳性细胞数目多少分为增多(7例)、减少(20例)及正常(7例)3组,统计学分析增多组均值(164.4个/mm^2)明显高于对照组(58.3个/mm^2);减少组均值(16.5个/mm^2)组显低于对照组;而正常组均值(69.8个/mm^2)与对照组无显著差异。 相似文献
10.
VEGF-C和VEGF-D蛋白表达在胰腺癌淋巴转移中的意义 总被引:1,自引:1,他引:0
目的探讨胰腺癌中VEGF-C、VEGF-D蛋白表达与淋巴结转移之间的相关关系,阐明癌周淋巴管增生在胰腺癌淋巴转移中的作用及意义。方法免疫组化检测30例胰腺癌组织中VEGF-C、VEGF-D的表达及其与临床病理、淋巴结转移的关系。结果胰腺癌VEGF-C、VEGF-D蛋白表达阳性率分别为73%(22/30)、57%(17/30),肿瘤周边部位显著高于肿瘤中心部位,其表达与肿瘤的部位、分化程度、组织学类型无关,与肿瘤的TNM分期有关,Ⅲ~Ⅳ期显著高于Ⅰ~Ⅱ期。在VEGF-C、VEGF-D蛋白阳性组,淋巴结转移均显著增多。结论VEGF-C和VEGF-D与诱导胰腺癌淋巴管生成,促进肿瘤细胞淋巴道转移有关。 相似文献