Validation of Nomograms Predicting Lymph Node Involvement in Patients with Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection

Abstract

Our aim was to validate Briganti's nomograms predicting the probability of lymph node involvement (LNI) in prostate cancer (PCa). Clinicopathological data of 256 PCa patients who underwent extended pelvic lymph node dissection (ePLND) and radical prostatectomy (RP) were obtained from two Bulgarian institutions. Predicted probabilities of LNI were assessed using Briganti's nomograms based on ePLND. In addition to the established basic LNI predictors, Briganti's nomograms included the number of lymph nodes removed (version 2006) and the number and percentage of positive biopsy cores (versions 2007 and 2012). The accuracy of these nomograms was compared with the updated Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram (version 2011). Receiver-operating characteristics analysis was done to assess the discriminative ability of each of the nomograms applied.All of Briganti's nomograms showed a higher predictive accuracy as compared with the updated MSKCC nomogram. The respective AUC values were calculated as 0.847, 0.837, 0.858 and 0.875 for the four Briganti nomograms, and 0.770 for the updated MSKCC nomogram, respectively. Despite the potential for heterogeneity in patient selection and management, all predictions demonstrated high concordance with actual observations. Compared with other similar prognostic tools the updated Briganti nomogram (version 2012) showed the highest predictive accuracy and should therefore be preferred.

First Nomogram Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients Undergoing Radioisotope Guided Sentinel Lymph Node Dissection

“…In the Update Nomogram of Briganti et al [5] , the percentage of positive cores is the most accurate predictor of LNI. This was also confirmed by external validation studies [29,30] . On the flip side, the sentinel nomogram reflects the reality of care.…”

“…However, the staging accuracy and the rates of LNI patients detected by sPLNDs in the monitored sample compare well with data from other sPLND-experienced centers [13] . Ideally, one should also externally validate the reliability of the sentinel nomogram [29][30][31] .…”

Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017

“…Current guidelines (EAU, National Comprehensive Cancer Network [NCCN]) recommend performing extended pelvic lymph node dissection for men with high-risk and locally APC treated by RP particularly if the risk for lymph node metastases based on available nomograms is estimated to be !5% despite the fact that there are no data from randomised prospective trials supporting an improvement in outcome with lymph node dissection [10][11][12]. The impact of minimal template versus extended lymph node dissection is not known and the pathological processing and reporting of the dissected material is not well defined.…”

“…o Taxane in men with symptomatic mCRP C who had progressive disease as best response to first-line abiraterone or enzalutamide: 96% o Taxane in men with symptomatic mCRPC and secondary (acquired) resistance or abiraterone first-line of use after progression) by followed response (initial enzalutamide: 90% o Abiraterone or enzalutamide for asymptomatic men with mCRPC progressing on or after docetaxel for mCRPC (without prior abiraterone or enzalutamide): 92% o Abiraterone or enzalutamide for symptomatic men with mCRPC progressing on or after docetaxel for mCRPC (without prior abiraterone or enzalutamide): 76% There were also several notable areas of panellist disagreement including but not limited to: (1) chemohormonal therapy in ''low-volume'' CNPC, (2) treatment of the primary tumour in metastatic disease, (3) radium-223 combination strategies, (4) use of platinum in mCRPC, (5) definition of aggressive variant prostate cancer, (6) use, schedule, and duration of osteoclast-targeted therapies especially in the context of newer survival prolonging mCRPC therapies; (7) use of next-generation imaging; (8) how to advise men with known BRCA2, BRCA1, or ATM mutations; (9) adjuvant RT; (10) when to initiate SRT; (11) definition and treatment for oligometastatic synchronous and metachronous prostate cancer; (12) health status assessment in patients aged !70 yr; and (13) pathology reporting of men undergoing a mCRPC biopsy.…”

Performance characteristics of prostate-specific antigen density and biopsy core details to predict oncological outcome in patients with intermediate to high-risk prostate cancer underwent robot-assisted radical prostatectomy

“…Briganti et al later updated their analyses by increasing the number of cores taken from biopsy, and they repeatedly emphasized that the inclusion of the percentage of positive cores should be mandatory in the prediction model for lymph node invasion of PCa [7, 19]. Hinev, et al demonstrated that Briganti’s nomograms showed a higher predictive accuracy for lymph node invasion as compared with the Memorial Sloan-Kettering Cancer Center nomogram, which provide predictions without information on biopsy cores [20]. Despite the positive correlation between the percentage of positive cores and the percentage of cancer extent in each positive core, each of the two factors also shows an independent predictive value for the advanced tumor stage and an increased index tumor volume in our entire cohort.…”