Abstract
BackgroundWe aimed to establish an external validation of the Briganti 2019 nomogram in a Japanese cohort to preoperatively evaluate the probability of lymph node invasion in patients with high-risk, clinically localized prostate cancer.MethodsThe cohort consisted of 278 patients with prostate cancer diagnosed using magnetic resonance imaging-targeted biopsy who underwent radical prostatectomy and extended pelvic lymph node dissection from 2012 to 2020. Patients were rated using the Briganti 2019 nomogram, which evaluates the probability of lymph node invasion. We used the area under curve of the receiver operating characteristic analysis to quantify the accuracy of the nomogram.ResultsNineteen (6.8%) patients had lymph node invasion. The median number of lymph nodes removed was 18. The area under the curve for the Briganti 2019 was 0.71. When the cutoff was set at 7%, 84 (30.2%) patients with extended pelvic lymph node dissection could be omitted, and only 1 (1.2%) patient with lymph node invasion would be missed. Sensitivity, specificity, and negative predictive values at the 7% cutoff were 94.7, 32.0, and 98.8%, respectively.ConclusionThis external validation showed that the Briganti 2019 nomogram was accurate, although there may still be scope for individual adjustments.
Highlights
Pelvic lymph node dissection (PLND) represents the gold standard for detecting occult lymph node invasion (LNI) and confirming accurate staging of high-risk prostate cancer [1]
The area under the curve (AUC) of the Briganti 2019 nomogram was the lowest compared with that of the other nomograms calculated under the same conditions
Oderda et al highlighted a similar trend in their study, where the lowest AUC was obtained from the Briganti 2019 nomogram when compared to the other validated nomograms [23]
Summary
Pelvic lymph node dissection (PLND) represents the gold standard for detecting occult lymph node invasion (LNI) and confirming accurate staging of high-risk prostate cancer [1]. In the current era of widespread prostate-specific antigen (PSA)-based population screening, the actual number of cases with LNI is small, compared to the number of PLNDs performed. It is, of great importance to focus on the indications for PLNDs to avoid unnecessary invasion and the associated complications. We aimed to establish an external validation of the Briganti 2019 nomogram in a Japanese cohort to preoperatively evaluate the probability of lymph node invasion in patients with high-risk, clinically localized prostate cancer. Conclusion This external validation showed that the Briganti 2019 nomogram was accurate, there may still be scope for individual adjustments
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