Yonsei nomogram to predict lymph node invasion in Asian men with prostate cancer during robotic era

Abstract

Objective• To develop a novel nomogram to predict lymph node invasion (LNI) in Asian men undergoing radical prostatectomy (RP) and pelvic LN dissection (PLND) for localised prostate cancer. Patients and Methods• The patient cohort included 541 patients who underwent robot-assisted RP and PLND by a single surgeon between January 2008 and December 2011.• Patients with dissection of <10 LNs, prostate-specific antigen (PSA) levels of >50 ng/mL, incomplete biopsy data, and treatment with neoadjuvant therapy were excluded. Results• The median (interquartile range) number of LNs removed was 17 (14-22) and 45 patients (8.3%) had LN metastases.• Conclusions• We report a nomogram to predict LNI in Asian men with prostate cancer. The model demonstrated high accuracy and could be used for counselling patients and the selection of candidates for PLND.

Predicting the Probability of Lymph Node Involvement with Prostate Cancer Nomograms: Can We Trust the Prediction Models?

“…The AUC for prediction of LNI was 0.862, resembling our findings. 13,16 Regarding statistical and mathematical formulas to predict LNI, there has been quite an evolution to finally develop the Yale formula, the latter was developed with data of The National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Only data of patients with at least 10 LNs harvested was included; they found a specificity of 94.9% with a 15% cut-off value.…”

“…More than 20 models are available to this date to predict LNI in patients with PCa. Some of the models are the nomograms reported by (# harvested LN), 2007, 2007 (# positive cores), 2012, and 2017, Yonsei and Winter nomograms, linear formulas, such as the Roach formula, the Nguyen Formula and the Yale formula; Partin tables that have been validated multiple times, the last one in 2016, and the prediction models proposed by the MSKCC, Godoy prediction model and their web calculators, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Our aim is to evaluate the prediction ability of the most commonly used and best-performing prediction tools for LNI in PCa (MSKCC web calculator, Briganti v.2017, Yale formula and Partin tables v.2016) in a Latin-American population for the first time.…”

“…Cutoff values for each model were 2% (Partin), 7% (Briganti), 20% (MSKCC) and 15% (Yale formula), those were taken from the internal validation study of each prediction model as the best performing cutoff value to predict LNI. 13,15,16,18,22,23,26,27,30 Descriptive statistics were reported in terms of the frequency for categorical variables, the median with interquartile range (IQR) for continuous variables that did not follow a normal distribution. Significant differences (p < 0.05) between groups were assessed using the Fisher exact test for categorical variables and a Mann-Whitney U test for continuous variables in the comparison of positive LN (LN þ ) and negative LN (LN-) groups (►Table 1).…”

Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy

“…These make use of pre-operative variables, including Gleason score, clinical stage, PSA and, in certain cases, percentage involvement and number of positive biopsy cores, to assess the risk of lymph node involvement. [ 8 9 10 ] These nomograms are derived mostly from western cohorts and therefore a direct extrapolation of these data to our part of the world may not be reasonable. While our study falls short of creating a nomogram for the Indian population, it does provide valuable insight regarding the chances of lymph node positivity and the factors impacting the same in a contemporary cohort of Indian men undergoing robotic EPLND.…”

“…Various nomograms, based on pre-operative parameters, have been described to predict the probability of lymph node positivity. [ 8 9 10 ] The National Comprehensive Cancer Network (NCCN) guidelines recommend an extended pelvic lymph node dissection (EPLND) during radical prostatectomy in patients who have a greater than 2% nomogram-derived risk for pelvic lymph node metastases. [ 11 ]…”