Abstract
PurposeTo improve the performation of a nomogram for predicting side-specific extracapsular extension (SS-ECE).ResultsOne hundred and ninety-six patients (55.5%) had ECE on final pathology. Bilateral and unilateral ECE rate was 13.9% (49/353) and 41.6% (147/353), respectively. The mean age was 65.9 years and the mean serum prostate specific antigen (PSA) was 15.0 ng/ml. Based on multivariate logistic regression analysis, clinical stage (cStage), PSA, Gleason sum, percentage of positive cores, and ECE risk score were significant predictors of ECE. The current nomogram had higher predictive accuracy (0.851) and superior calibration. According to the decision curve analysis (DCA) results, the updated nomogram demonstrated a high net benefit across a wide range of threshold probabilities.Materials and MethodsWe studied 353 patients with cStage T1c-T3 prostate cancer underwent radical prostatectomy. The candidate predictors associated with ECE were cStage, PSA, Gleason sum, percentage of positive cores, maximum cancer percentage and ECE risk score from multi-parametric magnetic resonance imaging (MP-MRI). The receiver operating characteristic (ROC) analysis was performed and an updated nomogram was constructed. The DCA was performed to test the predictive ability of the nomogram. In addition, the validation and calibration of the Memorial Sloan-Kettering cancer center (MSKCC) nomograms were performed in the current subjects.ConclusionsPredictors, including cStage, PSA, Gleason sum, percentage of positive cores, maximum cancer percentage, and ECE risk score, were combined to construct a SS-ECE prediction nomogram. And the current nomogram might help urologists in decision-making process of preserving or resecting neurovascular bundles preoperatively.
Highlights
The presence of extracapsular extension (ECE), which frequently occurs posterolaterally in the region of the neurovascular bundle (NVB), is not uncommon in patients with prostate cancer [1]
Bilateral ECE was reported in 49 patients (13.9%), while unilateral left and right ECE was recorded in 87 (24.6%) and 60 (17.0%) patients, respectively
We developed a new predictive nomogram based on the data of prostate cancer in Chinese population, adding the ECE risk score based on multi-parametric magnetic resonance imaging (MP-MRI) [4, 5]
Summary
The presence of extracapsular extension (ECE), which frequently occurs posterolaterally in the region of the neurovascular bundle (NVB), is not uncommon in patients with prostate cancer [1]. Resection of the NVB substantially decreases the chance of recovering erectile function, but preservation of the nerve may lead to a positive surgical margin. It would benefit patients if surgeons documented the ECE as accurately as possible during the pre-operative evaluation. Www.impactjournals.com/oncotarget Variable ECE (n = 461) + (n = 245) Univariate P Multivariate OR (95%CI) P Age (years) 65.6±7.0
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