Giorgio Gandaglia1, Alberto Martini2, Guillaume Ploussard3, Nicola Fossati2, Armando Stabile2, Pieter De Visschere4, Hendrik Borgmann5, Isabel Heidegger6, Fabian Steinkohl7, Alexander Kretschmer8, Giancarlo Marra9, Romain Mathieu10, Cristian Surcel11, Derya Tilki12, Igor Tsaur5, Massimo Valerio13, Roderick Van den Bergh14, Piet Ost15, Paolo Gontero9, Francesco Montorsi2, Alberto Briganti2. 1. Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: gandaglia.giorgio@hsr.it. 2. Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. 3. Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, Toulouse, France. 4. Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium. 5. Department of Urology, University Hospital of Mainz, Mainz, Germany. 6. Department of Urology, University Hospital of Innsbruck, Innsbruck, Austria. 7. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria. 8. Department of Urology, Austria Ludwig-Maximilians University of Munich, Munich, Germany. 9. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy. 10. Department of Urology, CHU Rennes, Rennes, France. 11. Department of Urology, Fundeni Clinical Institute, Bucharest, Romania. 12. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 13. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 14. Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands. 15. Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
Abstract
The 2019 Briganti nomogram was developed to calculate the risk of lymph node invasion (LNI) and identify prostate cancer (PCa) patients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy who should be considered for an extended pelvic lymph node dissection (ePLND). Since its implementation is still limited by lack of a formal external validation, we aimed to validate this tool in a large contemporary cohort. We identified 487 patients diagnosed using MRI-targeted with concomitant systematic biopsy who underwent radical prostatectomy (RP) and an anatomically defined ePLND at six centers. The external validity of the 2019 Briganti nomogram for estimating LNI risk was assessed via calibration, discrimination, and decision curve analyses (DCAs). A total of 38 (8%) patients had LNI at final pathology. The median number of nodes removed was 18 (interquartile range 14-24). On external validation, the 2019 Briganti nomogram had an area under the receiver operating characteristic curve (AUC) of 79%. Although there was some miscalibration, this was at predicted probabilities >35% and therefore outside the clinically relevant range. DCA demonstrated that the 2019 Briganti nomogram improved clinical risk prediction against LNI threshold probabilities of ≤30%. For a 7% cutoff, 273 (56%) ePLNDs would be spared and only 2.6% LNIs would be missed. The 2019 Briganti nomogram was characterized by higher AUC compared to the 2012 and 2017 Briganti nomograms and the Memorial Sloan Kettering Cancer Center risk calculator (79% vs 75% vs 65% vs 74%) and demonstrated the highest net benefit on DCA. This first multi-institutional validation of the 2019 Briganti nomogram in predicting LNI in PCa patients diagnosed with MRI-targeted biopsy confirms the highest AUC, better calibration and the highest net benefit compared with available tools and should be adopted to identify candidates for ePLND among men diagnosed with MRI-targeted biopsy. PATIENT SUMMARY: We performed the first multi-institutional validation of the first nomogram predicting lymph node invasion specifically developed using data from prostate cancer patients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy. This nomogram exhibited excellent characteristics on external validation compared with available tools and should be adopted to identify candidates for extended pelvic lymph node dissection among men diagnosed with MRI-targeted biopsy.
The 2019 Briganti nomogram was developed to calculate the risk of lymph node invasion (LNI) and identify prostate cancer (PCa) patients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy who should be considered for an extended pelvic lymph node dissection (ePLND). Since its implementation is still limited by lack of a formal external validation, we aimed to validate this tool in a large contemporary cohort. We identified 487 patients diagnosed using MRI-targeted with concomitant systematic biopsy who underwent radical prostatectomy (RP) and an anatomically defined ePLND at six centers. The external validity of the 2019 Briganti nomogram for estimating LNI risk was assessed via calibration, discrimination, and decision curve analyses (DCAs). A total of 38 (8%) patients had LNI at final pathology. The median number of nodes removed was 18 (interquartile range 14-24). On external validation, the 2019 Briganti nomogram had an area under the receiver operating characteristic curve (AUC) of 79%. Although there was some miscalibration, this was at predicted probabilities >35% and therefore outside the clinically relevant range. DCA demonstrated that the 2019 Briganti nomogram improved clinical risk prediction against LNI threshold probabilities of ≤30%. For a 7% cutoff, 273 (56%) ePLNDs would be spared and only 2.6% LNIs would be missed. The 2019 Briganti nomogram was characterized by higher AUC compared to the 2012 and 2017 Briganti nomograms and the Memorial Sloan Kettering Cancer Center risk calculator (79% vs 75% vs 65% vs 74%) and demonstrated the highest net benefit on DCA. This first multi-institutional validation of the 2019 Briganti nomogram in predicting LNI in PCapatients diagnosed with MRI-targeted biopsy confirms the highest AUC, better calibration and the highest net benefit compared with available tools and should be adopted to identify candidates for ePLND among men diagnosed with MRI-targeted biopsy. PATIENT SUMMARY: We performed the first multi-institutional validation of the first nomogram predicting lymph node invasion specifically developed using data from prostate cancerpatients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy. This nomogram exhibited excellent characteristics on external validation compared with available tools and should be adopted to identify candidates for extended pelvic lymph node dissection among men diagnosed with MRI-targeted biopsy.
Authors: Piotr Zapała; Łukasz Fus; Zbigniew Lewandowski; Karolina Garbas; Łukasz Zapała; Barbara Górnicka; Piotr Radziszewski Journal: J Clin Med Date: 2021-11-27 Impact factor: 4.241
Authors: Nicola Frego; Marco Paciotti; Nicolò Maria Buffi; Davide Maffei; Roberto Contieri; Pier Paolo Avolio; Vittorio Fasulo; Alessandro Uleri; Massimo Lazzeri; Rodolfo Hurle; Alberto Saita; Giorgio Ferruccio Guazzoni; Paolo Casale; Giovanni Lughezzani Journal: Front Surg Date: 2022-02-25
Authors: Jesse Ory; Michael B Tradewell; Udi Blankstein; Thiago F Lima; Sirpi Nackeeran; Daniel C Gonzalez; Elie Nwefo; Joseph Moryousef; Vinayak Madhusoodanan; Susan Lau; Keith Jarvi; Ranjith Ramasamy Journal: World J Mens Health Date: 2022-01-02 Impact factor: 6.494