Optimization of prostate cancer patient lymph node staging via the integration of neutrophil–lymphocyte ratios, platelet–lymphocyte ratios, and 68Ga?PSMA?PET?derived SUVmax values

AbstractBackground

At present, standardized parameters for quantitatively evaluating 68Ga-PSMA-PET/CT outcomes when diagnosing lymph node metastasis in prostate cancer patients are lacking. Inflammatory hematological biomarkers offer value as robust predictors of certain cancer-related outcomes. The present study was thus developed to explore approaches to improving the utility of 68Ga-PSMA-PET/CT for diagnosing lymph node metastasis through the combined evaluation of inflammatory hematological markers in prostate cancer patients.

Methods

Pretreatment patient details including age, initial TPSA levels, hematological findings, biopsy pathology results (Gleason score and ISUP grouping), radical pathology results, and imaging details were collected. Optimal cutoff values for each predictor then being determined based upon Youden's index, with univariate and multivariate analyses were then used to identify independent predictors of lymph node metastasis and used to construct a nomogram.

Result

Independent predictors of lymph node metastasis in this patient cohort included SUVmax (odds ratio [OR]: 30.549, 95% confidence interval [CI]: 10.855–85.973, p?<?0.001), neutrophil-lymphocyte ratio (OR:8.221, 95%CI: 1.335–50.614, p?=?0.023), platelet-lymphocyte ratio (OR:8.221, 95% CI: 1.335–50.614, p?=?0.023), initial TPSA (OR:2.761, 95% CI: 1.132–6.733, p?=?0.026), and clinical T-stage (T3 vs. T2, OR:11.332, 95% CI:3.929–32.681, p?<?0.001; T4 vs. T2, OR:9.101, 95% CI:1.962–42.213, p?=?0.005), with corresponding optimal cutoff values of 2.3 (area under the curve [AUC]: 0.873, sensitivity: 0.736, specificity: 0.902), 1.72 (AUC: 0.558, sensitivity: 0.529, specificity: 0.643), 83.305 (AUC: 0.651, sensitivity: 0.299, specificity: 0.979), and 21.875 (AUC: 0.672, sensitivity: 0.736, specificity: 0.601). Subsequent nomogram construction was associated with good predictive ability, with a C-index of 0.887(95% CI: 0.793–0.981) and an AUC of 0.924 (95% CI: 0.882–0.965).

Conclusion

SUVmax, the neutrophil–lymphocyte ratio, the platelet–lymphocyte ratio, initial TPSA, and clinical T-stage represent valuable independent predictors of lymph node metastasis in prostate cancer patients, offering an opportunity to further optimize lymph node staging for these patients.