External Validation of Nomogram Predicting the Probability of Specimen-Confined Disease (pT2-3a, R0N0) in Patients Undergoing Radical Prostatectomy and Pelvic Lymph Node Dissection

Abstract

Introduction: Before radical prostatectomy (RP), a nomogram [Briganti et al., Eur Urol 2012;61:584-592] permits to measure the probability of specimen-confined (SC) disease (pT2-pT3a, node negative with negative margins) in high-risk prostate cancer (PCa). The aim of our study was to perform an external validation of this nomogram. Materials and Methods: Between 2007 and 2011, 623 patients with high-risk PCa (prostate-specific antigen (PSA) >20 ng/ml and/or biopsy Gleason score ≥8 and/or clinical stage T3) underwent RP and pelvic lymph node dissection at tertiary referral centers. Multivariable logistic regression models predicting the presence of SC disease were built in; we then used the area under curve of the receiver operating characteristic analysis to quantify accuracy of the nomogram to predict SC disease. The extent of over- or underestimation was evaluated within calibration plots. Results: 29% (181/623) of men had SC disease at RP. Preoperative PSA, biopsy Gleason score and stage differed significantly (all p < 0.001) between men with SC disease and those without. External validation of the nomogram showed an acceptable accuracy (area under curve: 66.3, 95% CI 62.4-70%) and a perfect calibration plot. Conclusions: The external cohort validates the original nomogram, with perfect calibration characteristics. The adequate although reduced accuracy may reflect the wide spectrum and behavior of the so-called high-risk PCa.

External evaluation of the Briganti nomogram to predict lymph node metastases in intermediate-risk prostate cancer patients

“…In order to precise the clinical relevance of various thresholds, we analyzed the consequences of the application of a different threshold on the number of BPLNDs to perform in order to detect 1 LNI. The results summarizing the interest of the Briganti score according to the cut-off value used are shown in We acknowledge that the robot-assisted laparoscopic approach appeared, in this study, to retrieve a median number of lymph nodes inferior to the open approach, 9 (7)(8)(9)(10)(11)(12) versus 11 (8)(9)(10)(11)(12)(13)(14)(15)(16). These results are similar to other series of robotic BPLND [13,16].…”

External validation of the Briganti nomogram to estimate the probability of specimen‐confined disease in patients with high‐risk prostate cancer

“…Recently Mearini et al. reported the first external validation of Briganti's nomogram in a cohort of 623 men with high‐risk PCa. Preoperative PSA, biopsy Gleason score and stage differed significantly (all P < 0.001) between men with specimen‐confined disease and those without.…”

Clinical Outcome of Patients with Lymph Node-Positive Prostate Cancer following Radical Prostatectomy and Extended Sentinel Lymph Node Dissection

“…In our RRP patients (n = 819), pN1 patients were identified approximately 2-3 times more often than would have been expected using the common Partin tables, which had been adjusted using lPLND [20]. Keeping in mind perioperative complications regarding lymphoceles requiring treatment [21], it would probably be helpful to use the recent European nomograms adjusted for ePLND from now on, which are not yet widely used [22]. In our patient population, the number of LN metastases as well as LND served as significant predictors of RFS and CSS, and numerous studies support this conclusion [1,2,10,15,16,17,18].…”