Prospective Multicenter Study on the Predictive Role of Node-RADS Score in Patients With Prostate Cancer Who Are Candidates for Radical Prostatectomy: Comparative Analysis with Validated Nomograms and PET/CT Scan.

IF 6.3 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2026-08-21 DOI:10.1016/j.euf.2026.08.002

Alessandro Sciarra, Paolo Casale, Giulio Bevilacqua, Greta Basile, Valerio Santarelli, Nicolò Maria Buffi, Massimo Lazzeri, Giovanni Lunghezzani, Sara Lucciola, Emanuele Messina, Ludovica Laschena, Ailin Dehghanpour, Giovanni Battista Di Pierro, Giorgio Franco, Francesco Del Giudice, Alessandro Gentilucci, Piervito Dipinto, Roberta Corvino, Stefano Salciccia, Fabio Massimo Magliocca, Valeria Panebianco

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引用次数: 0

Abstract

Background and objective: This is the first prospective study analyzing the predictive value of preoperative Node-Reporting And Data System (RADS) determination at imaging for pelvic lymph node (PLN) involvement in cases of prostate cancer (PCa) considered for radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). Node-RADS was compared with the validated predictive nomograms Briganti 2012, Gandaglia 2017, and Briganti 2019, and with prostate-specific membrane antigen - positron emission tomography/computed tomography (PSMA-PET/CT) total body scan.

Methods: A total of 267 patients with a histological diagnosis of PCa undergoing RP with an ePLND were prospectively examined. Overall, n = 104 patients underwent PSMA-PET/CT. Node-RADS determination of PLNs was centrally performed using preoperative magnetic resonance imaging and compared with the validated nomograms and PSMA-PET/CT. Correspondence in terms of positivity and localization with final pathology was analyzed.

Results: Node-RADS exceeded PSMA-PET/CT in overall accuracy (area under the curve [AUC] 0.637 vs 0.526), whereas the Briganti 2019 nomogram achieved the highest AUC (0.711). Combining Node-RADS and Briganti 2019 improved performance further (AUC 0.719). Node-RADS showed high specificity (0.993) and positive predictive value (0.506), useful to confirm nodal involvement, whereas Briganti 2019 demonstrated high sensitivity (0.952) and excellent NPV (0.960), useful to exclude nodal disease. PET/CT exhibited limited sensitivity and anatomical correspondence. At multivariate analysis, a high Node-RADS score (4-5) and pathological tumor (pT) stage (pT3) were the only variables associated with a higher risk of positive PLNs involvement at final pathology (adjusted odds ratio [aOR]: 12.60, 95% confidence interval [CI] 2.99-52.96, p < 0.001 for Node-RADS 4-5 and aOR 16.98, 95% CI 4.29-67.17, p < 0.001 for pT3b).

Conclusions: Node-RADS, especially when combined with the Briganti 2019 nomogram, showed promising performance as a structured radiologic tool for preoperative nodal staging in this selected ePLND-eligible cohort.

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淋巴结- rads评分在前列腺癌患者根治性前列腺切除术中的预测作用的前瞻性多中心研究：与有效的nomogram和PET/CT扫描的比较分析

背景与目的：这是第一个前瞻性研究，分析术前淋巴结报告和数据系统（RADS）在前列腺癌（PCa）考虑根治性前列腺切除术（RP）合并扩展盆腔淋巴结清扫（ePLND）的病例中盆腔淋巴结（PLN）累及的影像学预测价值。将nod - rads与经验证的预测图Briganti 2012、Gandaglia 2017和Briganti 2019进行比较，并与前列腺特异性膜抗原-正电子发射断层扫描/计算机断层扫描（PSMA-PET/CT）全身扫描进行比较。方法：对267例组织学诊断为PCa的患者进行RP合并ePLND的前瞻性检查。总体而言，n = 104例患者接受了PSMA-PET/CT检查。采用术前磁共振成像集中进行节点- rads测定，并与验证的图和PSMA-PET/CT进行比较。分析了阳性和定位与最终病理的对应关系。结果：Node-RADS在总体准确度上优于PSMA-PET/CT（曲线下面积[AUC] 0.637 vs 0.526），而Briganti 2019 nomogram AUC最高（0.711）。结合Node-RADS和Briganti 2019进一步提高了性能（AUC为0.719）。cancer - rads具有高特异性（0.993）和阳性预测值（0.506），可用于确认淋巴结累及，而Briganti 2019具有高敏感性（0.952）和良好的NPV(0.960)，可用于排除淋巴结疾病。PET/CT表现出有限的敏感性和解剖一致性。在多变量分析中，高Node-RADS评分（4-5）和病理肿瘤（pT）分期（pT3）是与最终病理中pln阳性累及风险较高相关的唯一变量（调整优势比[aOR]: 12.60, 95%可信区间[CI] 2.99-52.96, p）结论：Node-RADS，特别是与Briganti 2019 nomogram相结合时，在本选择的符合eplnd条件的队列中，作为术前淋巴结分期的结构化放射学工具显示出良好的性能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.