Working Paper Article Version 1 This version is not peer-reviewed

External validation of the Briganti nomogram to predict lymph node invasion in prostate cancer - setting a new threshold value.

Version 1 : Received: 9 May 2021 / Approved: 11 May 2021 / Online: 11 May 2021 (10:39:13 CEST)

A peer-reviewed article of this Preprint also exists.

Małkiewicz, B.; Ptaszkowski, K.; Knecht, K.; Gurwin, A.; Wilk, K.; Kiełb, P.; Dudek, K.; Zdrojowy, R. External Validation of the Briganti Nomogram to Predict Lymph Node Invasion in Prostate Cancer—Setting a New Threshold Value. Life 2021, 11, 479. Małkiewicz, B.; Ptaszkowski, K.; Knecht, K.; Gurwin, A.; Wilk, K.; Kiełb, P.; Dudek, K.; Zdrojowy, R. External Validation of the Briganti Nomogram to Predict Lymph Node Invasion in Prostate Cancer—Setting a New Threshold Value. Life 2021, 11, 479.

Journal reference: Life 2021, 11, 479
DOI: 10.3390/life11060479

Abstract

Introduction: The aim of the study was to test and validate the performance of the 2012 Briganti nomogram as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with extended pelvic lymph node dissection (PLND), to examine their performance and to analyse the therapeutic impact of using different nomogram cut-off . Material and methods: The study group consisted of 222 men with clinically localized prostate cancer (PCa) who underwent RP with ePLND between 01/2012 and 10/2018. Measurements included: preoperative PSA, clinical stage (CS), primary and secondary biopsy Gleason pattern and percentage of positive cores. The area under curve (AUC) of the receiver operator characteristic analysis was appointed to quantify accuracy of the primary nomogram model to predict LNI. The extent of estimation associated with the use of this model was graphically depicted using calibration plots. Results: The median number of removed lymph nodes was 16 (IQR 12-21). A total of 53 of 222 patients (23,9%) had LNI. Preoperative clinical and biopsy characteristics differed significantly (all p<0.005) between men with and without LNI. A nomogram-derived cut-off of 7% could lead to a reduction of 43% (95/222) of lymph node dissection, while missing 19% (10/53) of patients with LNI. The sensitivity, specificity, and negative predictive value associated with the 7% cut-off were 81.1%, 50.3%, and 96.3%, respectively. Conclusions: Analysed nomogram demonstrated high accuracy for LNI prediction. A nomogram-derived cutoff of 7% confirmed good performance characteristics within a first external validation cohort from Poland.

Keywords

prostate cancer; radical prostatectomy; pelvic lymph node dissection; lymph node invasion; preoperative nomogram

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