Main Article Content
Purpose;Nowaday,Most prostate cancer patients who wait for Radical prostatectomy have underwent CT imaging preoperatively. We evaluated the accuracy to CT in detecting lymph node metastasis of radical prostatectomy (RP) patients retrospectively.
Methods; The total 281 prostate cancer patients were performed Radical prostatectomy at Rajavithi hospital since Jan 2012 to Dec 2016 and met criteria were 150 patients.Retrospective data was done to evaluate accuracy of CT for detection LN metastasis in prostate cancer and subgroup analysis base on D’Amico risk classification. Statistic analysis of data was performed using percentage,mean,mode for descriptive data and Student T-test,Mann-Whitney U test,Chi-square test and Fisher Exact test for comparisons data.Nomogram performance was assessed by AUC for validation Rajavithi patients about lymph node involvement (LVI)
Results;One hundred and eleven patients underwent laparoscopic radical protatectomy (74%) and underwent retropubic radical prostatectomy (RRP) (26%) .CT scan showed sensitivity and specificity in predicting LNI of 54.55% (6 in 11) and 94.2 %(131 in 139) ,and subgroup analysis found that low risk group(25 patients), CT scan can detect LNI only one patient but pathologic finding was negative (PPV 0% and NPV 100%), intermediate risk group (72 patients) had PPV 25% and NPV 100%(P= 0.002) and high risk group(53 patients) had PPV 55.56% and NPV 88.64%(P=0.003) .Statistic significant only in intermediate and high risk groups. ROC curve analysis predict LNI with CT AUC 69 % and Partin table nomogram AUC 78%
Conclusions; CT scan can detect LNI in low risk group but benefit was limited. We concluded that CT could be more benefit in intermediate to high risk prostate cancer for detecting LN metastasis and predictive normogram could be accepted in accuracy
2.ธนพล ทนคำดี.รายงานสถิติโรคมะเร็งประจำปี หน่วยทะเบียนมะเร็ง คณะแพทยศาสตร์รามาธิบดี (พ.ศ 2553-2557).
3. Gabriele D, Collura D, Oderda M, Stura I, Fiorito C, Porpiglia F,et al.Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database. World J Urol. 2016;34(4):517-23.
4. Dong F, attan MW, Steyerberg EW, Jones JS, Stephenson AJ, Schröder FH,et al. Validation of pretreatment nomograms for predicting indolent prostate cancer: efficacy in contemporary urological practice. J Urol. 2008;180(1):150-4.
5.Hansen J, Becker A, Kluth LA, Rink M, Steuber T, Zacharias M,et al. Assessing the clinical benefit of a nomogram to predict specimen-confined disease at radical prostatectomy in patients with
high-risk prostate cancer: An external validation. Urol Oncol. 2015;33(9):384.e1-8.
6.Gupta RT, Brown AF, Silverman RK, Tay KJ, Madden JF, George DJ, et al. Can Radiologic Staging With Multiparametric MRI Enhance the Accuracy of the Partin Tables in Predicting Organ-Confined Prostate Cancer? AJR Am J Roentgenol. 2016;207(1):87-95.
7.Moschini M,Sharma V,Zattoni F,Boorjian S A,Frank I, Gettman M T,et al.Risk Stratification of pND Prostate Cancer after Radical Prostatectomy from a Large Single Institutional Series with Long-Term Followup.J Urol. 2016;1773-8.
8. Abdollah F, Cozzarini C, Sun M, Suardi N, Gallina A, Passoni NM et al.Assessing the most accurate formula to predict the risk of lymph node metastases from prostate cancer in contemporary patients treated with radical prostatectomy and extended pelvic lymph node dissection. Radiother Oncol. 2013;109(2):211-6.
9.Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR et al. Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009;55(6):1251-65.
10.Naito S, Kuroiwa K, Kinukawa N, Goto K, Koga H, Ogawa O et al. Clinicopathological Research Group for Localized Prostate Cancer Investigators..Validation of Partin tables and development of a preoperative nomogram for Japanese patients with clinically localized prostate cancer using 2005 International Society of Urological Pathology consensus on Gleason grading: data from the Clinicopathological Research Group for Localized Prostate Cancer. J Urol. 2008;180(3):904-9; discussion 909-10.
11. Deserno WM, Debats OA, Rozema T, Fortuin AS, Heesakkers RA, Hoogeveen Y,et al.Comparison of nodal risk formula and MR lymphography for predicting lymph node involvement in prostate cancer. Int J Radiat Oncol Biol Phys. 2011; 81(1): 8-15.
12. Heesakkers RA, Hövels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP,et al.MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol. 2008; 9(9): 850-6.
13.Oyen RH, Van Poppel HP, Ameye FE, Van de Voorde WA, Baert AL, Baert LV et al. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle
aspiration biopsy: prospective study of 285 patients. Radiology. 1994;190(2):315-22.