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Li Z, Huang Y, Zhao D, Luo X, Wu Z, Zheng X, Xie Y, Liu Y, Wu J, Peng Y, Li Y, Zhou F. Development and internal validation of a novel nomogram for predicting lymph node invasion for prostate cancer patients undergoing extended pelvic lymph node dissection. Front Oncol 2023; 13:1186319. [PMID: 37223684 PMCID: PMC10202171 DOI: 10.3389/fonc.2023.1186319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Background Few studies have focused on the performance of Briganti 2012, Briganti 2017 and MSKCC nomograms in the Chinese population in assessing the risk of lymph node invasion(LNI) in prostate cancer(PCa) patients and identifying patients suitable for extended pelvic lymph node dissection(ePLND). We aimed to develop and validate a novel nomogram based on Chinese PCa patients treated with radical prostatectomy(RP) and ePLND for predicting LNI. Methods We retrospectively retrieved clinical data of 631 patients with localized PCa receiving RP and ePLND at a Chinese single tertiary referral center. All patients had detailed biopsy information from experienced uropathologist. Multivariate logistic-regression analyses were performed to identify independent factors associated with LNI. The discrimination accuracy and net-benefit of models were quantified using the area under curve(AUC) and Decision curve analysis(DCA).The nonparametric bootstrapping were used to internal validation. Results A total of 194(30.7%) patients had LNI. The median number of removed lymph nodes was 13(range, 11-18). In univariable analysis, preoperative prostate-specific antigen(PSA), clinical stage, biopsy Gleason grade group, maximum percentage of single core involvement with highest-grade PCa, percentage of positive cores, percentage of positive cores with highest-grade PCa and percentage of cores with clinically significant cancer on systematic biopsy differed significantly. The multivariable model that included preoperative PSA, clinical stage, biopsy Gleason grade group, maximum percentage of single core involvement with highest-grade PCa and percentage of cores with clinically significant cancer on systematic biopsy represented the basis for the novel nomogram. Based on a 12% cutoff, our results showed that 189(30%) patients could have avoided ePLND while only 9(4.8%) had LNI missing ePLND. Our proposed model achieved the highest AUC (proposed model vs Briganti 2012 vs Briganti 2017 vs MSKCC model: 0.83 vs 0.8 vs 0.8 vs 0.8, respectively) and highest net-benefit via DCA in the Chinese cohort compared with previous nomograms. In internal validation of proposed nomogram, all variables had a percent inclusion greater than 50%. Conclusion We developed and validated a nomogram predicting the risk of LNI based on Chinese PCa patients, which demonstrated superior performance compared with previous nomograms.
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Affiliation(s)
- Zhen Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yixin Huang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Diwei Zhao
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin Luo
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zeshen Wu
- Department of Urology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| | - Xinyi Zheng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Ye Xie
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yixuan Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jianwei Wu
- School of Clinical Medicine, Tianjin Medical University, Tianjin, China
| | - Yulu Peng
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yonghong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Capitanio U, Autorino R, Bandini M, Briganti A, Cheng L, Cooperberg MR, Dehò F, Gallina A, Klotz L, Lane B, Montironi R, Salonia A, Stief C, Tombal B, Montorsi F. Incidental Prostate Cancer (cT1a-cT1b) Is a Relevant Clinical and Research Entity and Should Be Fully Discussed in the International Prostate Cancer Guidelines. Eur Urol Oncol 2021; 5:S2588-9311(21)00049-3. [PMID: 33814342 DOI: 10.1016/j.euo.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Umberto Capitanio
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Marco Bandini
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew R Cooperberg
- Departments of Urology and Epidemiology & Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - Federico Dehò
- Unit of Urology, Ospedale ASST Sette Laghi, Varese, Italy
| | - Andrea Gallina
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Brian Lane
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Urology, Spectrum Health Hospital System, Grand Rapids, MI, USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy
| | - Andrea Salonia
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Stief
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Bertrand Tombal
- Service d'Urologie, Cliniques universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Francesco Montorsi
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
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