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Strandberg, S., Jonsson, J., Zarei, M., Aglund, K., Blomqvist, L. & Söderkvist, K. (2024). Baseline and early response 2-[18F]FDG-PET/MRI for prediction of radiotherapy outcome in uterine cervical squamous cell carcinoma: a prospective single-center observational cohort study. EJNMMI Reports, 8(1), Article ID 5.
Open this publication in new window or tab >>Baseline and early response 2-[18F]FDG-PET/MRI for prediction of radiotherapy outcome in uterine cervical squamous cell carcinoma: a prospective single-center observational cohort study
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2024 (English)In: EJNMMI Reports, E-ISSN 3005-074X, Vol. 8, no 1, article id 5Article in journal (Refereed) Published
Abstract [en]

Background: Should early response imaging predict tumor response to therapy, personalized treatment adaptations could be feasible to improve outcome or reduce the risk of adverse events. This prospective single-center observational study on 2-fluorine-18-fluoro-deoxy-glucose (2-[18F]FDG) positron-emission tomography/magnetic resonance imaging (PET/MRI) features aims to investigate the association between semantic 2-[18F]FDG-PET/MRI imaging parameters and outcome prediction in uterine cervical squamous cell carcinoma (CSCC) treated with radiotherapy.

Results: Eleven study participants with previously untreated CSCC were examined with 2-[18F]FDG-PET/MRI at baseline and approximately one week after start of curative radiotherapy. All study participants had at least 24 months clinical follow-up. Two patients relapsed during the follow-up period. Reduced tumor size according to visual assessment was present in 9/11 participants (median change in sum of largest diameters (SLD) − 10.4%; range − 2.5 to − 24.6%). The size reduction was less pronounced in the relapse group compared to the no relapse group, with median change in SLD − 4.9%, versus − 10.4%. None of the reductions qualified as significantly reduced or increased in size according to RECIST 1.1., hence all participants were at this stage classified as non-responders/stable disease. Median baseline functional tumor volume (FTV) for the relapse group was 126 cm3, while for the no relapse group 9.3 cm3. Median delta FTV in the relapse group was 50.7 cm3, representing an actual increase in metabolically active volume, while median delta FTV in the no relapse group was − 2.0 cm3. Median delta apparent diffusion coefficient (ADC) was lower in the relapse group versus the no relapse group (− 3.5 mm2/s vs. 71 mm2/s).

Conclusions: Early response assessment with 2-[18F]FDG-PET/MRI identified potentially predictive functional imaging biomarkers for prediction of radiotherapy outcome in CSCC, that could not be recognized with tumor measurements according to RECIST 1.1. These biomarkers (delta FTV and delta ADC) should be further evaluated.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-222628 (URN)10.1186/s41824-024-00188-7 (DOI)
Funder
Swedish Cancer SocietyUmeå UniversityRegion Västerbotten
Available from: 2024-03-22 Created: 2024-03-22 Last updated: 2024-03-25Bibliographically approved
Holmberg, L., Skogmar, S., Garmo, H., Hagberg, O., Häggström, C., Gårdmark, T., . . . Liedberg, F. (2024). Cumulative incidence of and risk factors for BCG infection after adjuvant BCG instillations. BJU International
Open this publication in new window or tab >>Cumulative incidence of and risk factors for BCG infection after adjuvant BCG instillations
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2024 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: To investigate the cumulative incidence proportion of disseminated or local Bacillus Calmette-Guérin (BCG) infections after adjuvant BCG instillations in patients with non-muscle-invasive bladder cancer (NMIBC).

PATIENTS AND METHODS: We analysed the timing and occurrence of BCG infections and absolute and relative risk in relation to patient characteristics available in the Swedish nationwide database 'BladderBaSe 2.0'. The cumulative incidence proportion of a BCG infection was indicated by a reported diagnosis of tuberculosis (TB) in the patient registry or filing a prescription for tuberculostatic drugs.

RESULTS: The cumulative incidence proportion was 1.1% at the 5-year follow-up in 5033 patients exposed to adjuvant BCG instillations. The incidence rate was highest during the first 2 years after start of BCG instillations. Women had a lower risk than men (hazard ratio 0.23, 95% confidence interval 0.07-0.74). Age and calendar time at diagnosis, comorbidity, tumour risk group, previous medication with corticosteroids, immunosuppressive drugs, or time between transurethral resection of the bladder tumour and commencing the adjuvant BCG instillation were not associated with risk.

CONCLUSIONS: These data further supports that the overall risk of a BCG infection after BCG-instillation treatment for NMIBC is low. The great majority of infections occur in the first 2 years, calling for an awareness of the diverse symptoms of BCG infection during this period. We provide evidence for male sex as a risk factor; however, the statistical precision is low and with a risk of selection bias, making it difficult to rule out the other suggested risk factors without further studies with different approaches.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
BCG instillations, cumulative incidence proportion, local or systemic BCG infections, non-muscle-invasive bladder cancer, risk factors
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-221629 (URN)10.1111/bju.16303 (DOI)38403809 (PubMedID)2-s2.0-85186546298 (Scopus ID)
Funder
Swedish Cancer Society, CAN 2022/1971Swedish Cancer Society, CAN 2023/2807Swedish Research Council, 2021-00859
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-03-13
Liedberg, F., Hagberg, O., Aljabery, F., Gårdmark, T., Jahnson, S., Jerlström, T., . . . Bobjer, J. (2024). Diagnostic pathways and treatment strategies in upper tract urothelial carcinoma in Sweden between 2015 and 2021: a population-based survey. Scandinavian journal of urology, 59, 19-25
Open this publication in new window or tab >>Diagnostic pathways and treatment strategies in upper tract urothelial carcinoma in Sweden between 2015 and 2021: a population-based survey
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2024 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 59, p. 19-25Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To report national data on diagnostics and treatment of upper tract urothelial carcinoma (UTUC) from the Swedish National Registry of Urinary Bladder Cancer (SNRUBC).

PATIENTS AND METHODS: Data from 2015 to 2021 were retrieved, and descriptive analyses were performed regarding incidence, diagnostic modalities, preoperative tumor staging, quality indicators for treatment including the use of standardized care pathways (SCP) and multidisciplinary tumor boards (MDTB). Time trends were explored for the study period.

RESULTS: Registrations included 1,213 patients with renal pelvic cancer and 911 patients with ureteric cancer with a median age of 74 (interquartile range [IQR] 70-77) and 75 (IQR 71-78) years, respectively. Incidence rates of UTUC were stable, as were proportions of curative treatment intent. Median number of days from referral to treatment was 76 (IQR 57-99) and 90 (IQR 72-118) days, respectively, for tumors of the renal pelvis and ureter, which remained unchanged after introduction of SCP in 2016. Noticeable trends included stable use of kidney-sparing surgery and increased use of MDTB. For radical nephroureterectomy (RNU), robot-assisted technique usage increased even for non-organ-confined tumors (cT3-4) and in one out of three patients undergoing RNU a bladder cuff excision was not registered.

CONCLUSIONS: The population-based SNRUBC with high coverage contributes to the knowledge about UTUC with granular and generalizable data. The present study reveals a high proportion of patients not subjected to curatively intended treatment and suggests unmet needs to shorten lead times to treatment and use of bladder cuff excision when performing radical surgery for UTUC in Sweden.

Keywords
Upper tract urothelial carcinoma, Epidemiology, Ureteric cancer, Renal pelvic cancer, Nephroureterectomy
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-220006 (URN)10.2340/sju.v59.16281 (DOI)38226846 (PubMedID)2-s2.0-85182543992 (Scopus ID)
Funder
Swedish Cancer Society, CAN 2020/0709Swedish Research Council, 2021-00859Region Skåne, EGSKANE-622351Stiftelsen Gösta Jönssons forskningsfondStiftelsen Hillevi Fries forskningsfond
Available from: 2024-01-31 Created: 2024-01-31 Last updated: 2024-01-31Bibliographically approved
Bendsöe, N., Paoli, J., Söderkvist, K., Persson, B., Halldin, C., Ihrlund, L. & Wolodarski, M. (2023). A Non-Interventional Study on Vismodegib for Basal Cell Carcinoma in Swedish Patients. Dermatology Practical and Conceptual, 13(2), Article ID e2023211.
Open this publication in new window or tab >>A Non-Interventional Study on Vismodegib for Basal Cell Carcinoma in Swedish Patients
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2023 (English)In: Dermatology Practical and Conceptual, E-ISSN 2160-9381, Vol. 13, no 2, article id e2023211Article in journal (Refereed) Published
Abstract [en]

Introduction: Real-life data on vismodegib in advanced basal cell carcinoma (aBCC) are limited. Optimal treatment duration is left to the discretion of the physician.

Objectives: To assess the effectiveness, safety and treatment pattern for vismodegib in aBCC in clinical practice.

Methods: In this multicenter, non-interventional, prospective study, 49 Swedish patients planned for vismodegib treatment were included. The treatment pattern observed was treatment until remission, allowing unlimited discontinuations/pauses.

Results: The majority of patients (93.8%), discontinued at least once during the study. Compared to earlier studies there was a decrease of more than 2 months with actual drug intake, reducing the patients burden and costs, at the same time as a high number of responses were seen (87.8%). Median progression-free-survival was 16.7 months, and 90% of the patients were alive at 13.3 months. Ten patients were re-challenged with vismodegib at recurrence or progression, resulting in five partial remissions and three complete remissions.

Conclusions: Clinical response rates with vismodegib for aBCC were comparable to those of similar trials despite a shorter and more intermittent treatment duration. The majority of re-challenges lead to partial or complete remissions.

Place, publisher, year, edition, pages
Mattioli1885, 2023
Keywords
cohort-study, effectiveness, Non-interventional, prospective, safety
National Category
Dermatology and Venereal Diseases Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-212556 (URN)10.5826/dpc.1302a211 (DOI)37116181 (PubMedID)2-s2.0-85165686443 (Scopus ID)
Available from: 2023-08-07 Created: 2023-08-07 Last updated: 2023-08-07Bibliographically approved
Sandgren, K., Strandberg, S., Jonsson, J., Grefve, J., Keeratijarut Lindberg, A., Nilsson, E., . . . Riklund, K. (2023). Histopathology-validated lesion detection rates of clinically significant prostate cancer with mpMRI, [68Ga]PSMA-11-PET and [11C]Acetate-PET. Nuclear medicine communications, 44(11), 997-1004
Open this publication in new window or tab >>Histopathology-validated lesion detection rates of clinically significant prostate cancer with mpMRI, [68Ga]PSMA-11-PET and [11C]Acetate-PET
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2023 (English)In: Nuclear medicine communications, ISSN 0143-3636, E-ISSN 1473-5628, Vol. 44, no 11, p. 997-1004Article in journal (Refereed) Published
Abstract [en]

Objective: PET/CT and multiparametric MRI (mpMRI) are important diagnostic tools in clinically significant prostate cancer (csPC). The aim of this study was to compare csPC detection rates with [68Ga]PSMA-11-PET (PSMA)-PET, [11C] Acetate (ACE)-PET, and mpMRI with histopathology as reference, to identify the most suitable imaging modalities for subsequent hybrid imaging. An additional aim was to compare inter-reader variability to assess reproducibility.

Methods: During 2016–2019, all study participants were examined with PSMA-PET/mpMRI and ACE-PET/CT prior to radical prostatectomy. PSMA-PET, ACE-PET and mpMRI were evaluated separately by two observers, and were compared with histopathology-defined csPC. Statistical analyses included two-sided McNemar test and index of specific agreement.

Results: Fifty-five study participants were included, with 130 histopathological intraprostatic lesions >0.05 cc. Of these, 32% (42/130) were classified as csPC with ISUP grade ≥2 and volume >0.5 cc. PSMA-PET and mpMRI showed no difference in performance (P = 0.48), with mean csPC detection rate of 70% (29.5/42) and 74% (31/42), respectively, while with ACE-PET the mean csPC detection rate was 37% (15.5/42). Interobserver agreement was higher with PSMA-PET compared to mpMRI [79% (26/33) vs 67% (24/38)]. Including all detected lesions from each pair of observers, the detection rate increased to 90% (38/42) with mpMRI, and 79% (33/42) with PSMA-PET.

Conclusion: PSMA-PET and mpMRI showed high csPC detection rates and superior performance compared to ACE-PET. The interobserver agreement indicates higher reproducibility with PSMA-PET. The combined result of all observers in both PSMA-PET and mpMRI showed the highest detection rate, suggesting an added value of a hybrid imaging approach.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
Keywords
acetate-PET, detection rate, intraprostatic lesion, multiparametric MRI, prostate cancer, PSMA-PET
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-216125 (URN)10.1097/MNM.0000000000001743 (DOI)001083841200009 ()37615497 (PubMedID)2-s2.0-85174936230 (Scopus ID)
Funder
Swedish Cancer SocietyVästerbotten County Council
Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2023-11-06Bibliographically approved
Björeland, U., Notstam, K., Fransson, P., Söderkvist, K., Beckman, L., Jonsson, J., . . . Thellenberg-Karlsson, C. (2023). Hyaluronic acid spacer in prostate cancer radiotherapy: dosimetric effects, spacer stability and long-term toxicity and PRO in a phase II study. Radiation Oncology, 18(1), Article ID 1.
Open this publication in new window or tab >>Hyaluronic acid spacer in prostate cancer radiotherapy: dosimetric effects, spacer stability and long-term toxicity and PRO in a phase II study
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2023 (English)In: Radiation Oncology, ISSN 1748-717X, E-ISSN 1748-717X, Vol. 18, no 1, article id 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Perirectal spacers may be beneficial to reduce rectal side effects from radiotherapy (RT). Here, we present the impact of a hyaluronic acid (HA) perirectal spacer on rectal dose as well as spacer stability, long-term gastrointestinal (GI) and genitourinary (GU) toxicity and patient-reported outcome (PRO).

METHODS: In this phase II study 81 patients with low- and intermediate-risk prostate cancer received transrectal injections with HA before external beam RT (78 Gy in 39 fractions). The HA spacer was evaluated with MRI four times; before (MR0) and after HA-injection (MR1), at the middle (MR2) and at the end (MR3) of RT. GI and GU toxicity was assessed by physician for up to five years according to the RTOG scale. PROs were collected using the Swedish National Prostate Cancer Registry and Prostate cancer symptom scale questionnaires.

RESULTS: There was a significant reduction in rectal V70% (54.6 Gy) and V90% (70.2 Gy) between MR0 and MR1, as well as between MR0 to MR2 and MR3. From MR1 to MR2/MR3, HA thickness decreased with 28%/32% and CTV-rectum space with 19%/17% in the middle level. The cumulative late grade ≥ 2 GI toxicity at 5 years was 5% and the proportion of PRO moderate or severe overall bowel problems at 5 years follow-up was 12%. Cumulative late grade ≥ 2 GU toxicity at 5 years was 12% and moderate or severe overall urinary problems at 5 years were 10%.

CONCLUSION: We show that the HA spacer reduced rectal dose and long-term toxicity.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Hyaluronic Acid, Prostate cancer, Radiotherapy, Rectal toxicity
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-203799 (URN)10.1186/s13014-022-02197-x (DOI)000906713000001 ()36593460 (PubMedID)2-s2.0-85145492354 (Scopus ID)
Funder
Region VästernorrlandCancerforskningsfonden i NorrlandVisare Norr
Available from: 2023-01-20 Created: 2023-01-20 Last updated: 2023-09-05Bibliographically approved
Flygare, L., Erdogan, S. T. & Söderkvist, K. (2023). PET/MR versus PET/CT for locoregional staging of oropharyngeal squamous cell cancer. Acta Radiologica, 64(5), 1865-1872
Open this publication in new window or tab >>PET/MR versus PET/CT for locoregional staging of oropharyngeal squamous cell cancer
2023 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 64, no 5, p. 1865-1872Article in journal (Refereed) Published
Abstract [en]

Background: The value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for TN staging in head and neck cancer (HNC) has been proven in numerous studies. A few studies have investigated the value of FDG-PET/magnetic resonance imaging (MRI) in the staging of HNC; the combined results indicate potential for FDG-PET/MRI, but the scientific evidence remains weak.

Purpose: To compare performance of FDG-PET/CT and FDG-PET/MRI for locoregional staging in patients with oropharyngeal carcinomas.

Material and Methods: Two radiologists independently of each other retrospectively reviewed primary pre-therapeutic FDG-PET/CT and FDG-PET/MRI examinations from 40 individuals with oropharyngeal carcinomas. TN stage and primary tumor size were noted. The results were compared between observers and modalities and against TN stage set at a multidisciplinary conference.

Results: For nodal staging, PET/MRI had slightly higher specificity and accuracy than PET/CT for the most experienced observer. Both methods demonstrated excellent sensitivity (≥ 0.97 and 1.00, respectively), as well as high negative predictive values (≥ 0.95 and 1.00, respectively). No significant differences were found for tumor staging or measurement of maximum tumor diameter. There was a weak agreement (κ = 0.35–0.49) between PET/CT and PET/MRI for T and N stages for both observers. Inter-observer agreement was higher for PET/MRI than for PET/CT, both for tumor staging (κ = 0.57 vs. 0.35) and nodal staging (κ = 0.69 vs. 0.55). The agreement between observers was comparable to the agreement between methods.

Conclusion: PET/MRI may be a viable alternative to PET/CT for locoregional staging (TN staging) and assessment of maximal tumor diameter in oropharyngeal squamous cell cancer.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
18F-FDG, cancer staging, Head and neck cancer, positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-202001 (URN)10.1177/02841851221140668 (DOI)000893509800001 ()36464816 (PubMedID)2-s2.0-85144223158 (Scopus ID)
Funder
Swedish Cancer SocietyUmeå UniversityRegion Västerbotten, RV-940921
Available from: 2022-12-29 Created: 2022-12-29 Last updated: 2023-07-13Bibliographically approved
Liedberg, F., Hagberg, O., Häggström, C., Aljabery, F., Gårdmark, T., Hosseini, A., . . . Bobjer, J. (2023). Preoperative upper tract invasive diagnostic modalities are associated with intravesical recurrence following surgery for upper tract urothelial carcinoma: A population-based study. PLOS ONE, 18(2 February), Article ID e0281304.
Open this publication in new window or tab >>Preoperative upper tract invasive diagnostic modalities are associated with intravesical recurrence following surgery for upper tract urothelial carcinoma: A population-based study
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 2 February, article id e0281304Article in journal (Refereed) Published
Abstract [en]

Background: Intravesical recurrence (IVR) after surgery for upper tract urothelial carcinoma (UTUC) is a clinical problem. We investigated if preoperative invasive diagnostic modalities (IDM) such as antegrade/retrograde uretero-pyelography and/or selective urine cytology/barbotage, and URS with or without concomitant biopsy are associated with IVR after radical surgery for UTUC. Risk of death from urothelial cancer and all causes was investigated as secondary outcomes.

Methods: We investigated a population-based cohort of 1038 consecutive patients subjected to radical surgery for UTUC 2015–2019 in Sweden, using the Bladder Cancer Data Base Sweden (BladderBaSe 2.0), comprising all patients in the Swedish National Registry of Urinary Bladder Cancer. Risk estimates of IVR, death from urothelial cancer, and all causes was assessed using multivariable Cox regression models.

Results: The study included 536 cases with and 502 without preoperative IDM. IDM was associated with increased risk of IVR (HR 1.24, 95% CI 1.03–1.52) and risk of urothelial cancer death (HR 1.56, CI 1.12–2.18), compared to no IDM after a median follow-up of 1.3 yrs. Stratified analysis for tumor location showed that IDM was associated with risk of IVR in ureteric cancer (HR 1.66, 95% CI 1.21–2.28) but not in renal pelvic cancer (HR 1.07, 95% CI 0.81–1.41). Limitations included the observational setting and the lack of variables such as tumour grade, multifocality and preoperative hydronephrosis.

Conclusions: Worse outcomes for patients subjected to preoperative IDM highlight the need for carefully considering diagnostic decisions for UTUC patients, specifically in tumours located in the ureter.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-204744 (URN)10.1371/journal.pone.0281304 (DOI)000974706800001 ()36730353 (PubMedID)2-s2.0-85147318490 (Scopus ID)
Funder
Swedish Cancer Society, 2019/62Swedish Cancer Society, 2020/0709Swedish Research Council, 2021-00859Gyllenstiernska Krapperup FoundationStiftelsen Sigurd och Elsa Goljes minneFamiljen Bergqvists InsamlingsstiftelseRegion SkåneStiftelsen Gösta Jönssons forskningsfond
Available from: 2023-02-21 Created: 2023-02-21 Last updated: 2023-09-05Bibliographically approved
Bergengren, O., Belozerov, A., Bill-Axelson, A., Garmo, H., Hagberg, O., Aljabery, F., . . . Liedberg, F. (2023). Short term outcomes after robot assisted and open cystectomy: A nation-wide population-based study. European Journal of Surgical Oncology, 49(4), 868-874
Open this publication in new window or tab >>Short term outcomes after robot assisted and open cystectomy: A nation-wide population-based study
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2023 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 4, p. 868-874Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for urinary bladder cancer in a large population.

MATERIALS AND METHODS: We included all patients without distant metastases who underwent either RARC or ORC with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days, and secondary outcomes within 90 days of surgery were reoperations, Clavien 3-5 complications, total days alive and out of hospital, and mortality. The analysis was carried out using multivariate regression models.

RESULTS: Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures were to a larger extent performed during later years, at high volume centers (47% vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC were more commonly readmitted (29% vs. 25%). In multivariable analysis RARC was associated with decreased risk of Clavien 3-5 complications (OR 0.58, 95% CI 0.47-0.72), reoperations (OR 0.53, 95% CI 0.39-0.71) and had more days alive and out of hospital (mean difference 3.7 days, 95% CI 2.4-5.0).

CONCLUSION: This study illustrates the "real-world" effects of a gradual and nation-wide introduction of RARC. Patients operated with RARC had fewer major complications and reoperations but were more frequently readmitted compared to ORC. The observed differences were largely due to more wound related complications among patients treated with ORC.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Morbidity, Mortality, Open, Radical cystectomy, Robot assisted, Urinary bladder cancer
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-204795 (URN)10.1016/j.ejso.2023.01.023 (DOI)000966150500001 ()36759262 (PubMedID)2-s2.0-85148710732 (Scopus ID)
Funder
Swedish Cancer Society, 2019/62Swedish Cancer Society, 2020/0709Swedish Research Council, 2021-00859Region Skåne
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2024-02-01Bibliographically approved
Nilsson, E., Sandgren, K., Grefve, J., Jonsson, J., Axelsson, J., Keeratijarut Lindberg, A., . . . Nyholm, T. (2023). The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography. Communications Medicine, 3(1), Article ID 164.
Open this publication in new window or tab >>The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography
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2023 (English)In: Communications Medicine, E-ISSN 2730-664X, Vol. 3, no 1, article id 164Article in journal (Refereed) Published
Abstract [en]

Background: Multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) are widely used for the management of prostate cancer (PCa). However, how these modalities complement each other in PCa risk stratification is still largely unknown. We aim to provide insights into the potential of mpMRI and PET for PCa risk stratification.

Methods: We analyzed data from 55 consecutive patients with elevated prostate-specific antigen and biopsy-proven PCa enrolled in a prospective study between December 2016 and December 2019. [68Ga]PSMA-11 PET (PSMA-PET), [11C]Acetate PET (Acetate-PET) and mpMRI were co-registered with whole-mount histopathology. Lower- and higher-grade lesions were defined by International Society of Urological Pathology (ISUP) grade groups (IGG). We used PET and mpMRI data to differentiate between grades in two cases: IGG 3 vs. IGG 2 (case 1) and IGG ≥ 3 vs. IGG ≤ 2 (case 2). The performance was evaluated by receiver operating characteristic (ROC) analysis.

Results: We find that the maximum standardized uptake value (SUVmax) for PSMA-PET achieves the highest area under the ROC curve (AUC), with AUCs of 0.72 (case 1) and 0.79 (case 2). Combining the volume transfer constant, apparent diffusion coefficient and T2-weighted images (each normalized to non-malignant prostatic tissue) results in AUCs of 0.70 (case 1) and 0.70 (case 2). Adding PSMA-SUVmax increases the AUCs by 0.09 (p < 0.01) and 0.12 (p < 0.01), respectively.

Conclusions: By co-registering whole-mount histopathology and in-vivo imaging we show that mpMRI and PET can distinguish between lower- and higher-grade prostate cancer, using partially discriminative cut-off values.

Place, publisher, year, edition, pages
Springer Nature, 2023
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-224145 (URN)10.1038/s43856-023-00394-7 (DOI)001103117100002 ()37945817 (PubMedID)
Funder
Swedish Cancer Society, 21 1594 Pj
Available from: 2024-05-08 Created: 2024-05-08 Last updated: 2024-05-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3683-3763

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