MP57-06 EXTERNAL VALIDATION AND COMPARISON OF TWO NOMOGRAMS PREDICTING THE PROBABILITY OF LYMPH NODE INVASION IN PATIENTS SUBJECTED TO ROBOTIC RADICAL PROSTATECTOMY AND CONCOMITANT LYMPH NODE DISSECTION

Abstract

You have accessJournal of UrologyCME1 May 2022MP57-06 EXTERNAL VALIDATION AND COMPARISON OF TWO NOMOGRAMS PREDICTING THE PROBABILITY OF LYMPH NODE INVASION IN PATIENTS SUBJECTED TO ROBOTIC RADICAL PROSTATECTOMY AND CONCOMITANT LYMPH NODE DISSECTION Nicola Frego, Paciotti Marco, Davide Maffei, Pier Paolo Avolio, Roberto Contieri, Alessandro Uleri, Massimo Lazzeri, Alberto Saita, Paolo Casale, Nicolò Maria Buffi, and Giovanni Lughezzani Nicola FregoNicola Frego More articles by this author , Paciotti MarcoPaciotti Marco More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend an extended Pelvic Lymph Node Dissection (ePLND) in Prostate Cancer (PCa) patients with a non negligible risk of Lymph Node Invasion (LNI), according to available nomograms. The Briganti 2012 nomogram has been recently updated in Briganti 2019, to include information on Magnetic Resonance Imaging (MRI) and targeted biopsy (TB). The aim of the study is to validate and compare Briganti 2012 and 2019 nomograms in an external cohort of contemporary patients. METHODS: We retrospectively collected data of consecutive patients treated with Robot Assisted Radical Prostatectomy and ePLND at our center, between December 2014 and August 2021. Data included clinical, MRI, and pathological characteristics. The risk of LNI was calculated with the published regression coefficients. The Receiver Operator Characteristics (ROC) curve and Area Under the Curve (AUC) were used to evaluate the accuracy, while deLong method was used to compare models' accuracy. Calibration plot was used to evaluate the extend of over and under estimation of the models. Multivariate Logistic Regression Analysis (MVA) was performed to evaluate potential predictive factors of LNI. RESULTS: Overall, we analyzed data on 842 patients. Of them, 377 (44.8%) underwent MRI and TB. Median age at surgery was 64 years (IQR 59-69) and median tPSA was 7.04 ng/mL (IQR 5.11-10.4). Extra Capsular Extension and Seminal Vesicles Invasion (SVI) at MRI were observed in 15.4% and 5.4% of patients, respectively. The median primary and secondary GS were 3 and 4, respectively. The median percentage of positive cores was 35% (IQR 21.4-50). Finally, median Gleason Group at TB was 2 (IQR 2-3) and the median percentage of clinically significant random cores was 21% (IQR 0-42). A median of 13 (IQR 9-18) nodes per patient were removed, and 85 (10.1%) patients had LNI at final pathology. The AUCs for Briganti 2012 and 2019 were 0.84 and 0.79, respectively. The calibration plots showed a good correlation between the predicted probabilities and the observed proportion of LNI for both models. In patients with both SB and TB, Briganti 2012 accuracy was 0.815, and no significant difference was found between the two nomograms (p = 0.66). At MVA only PSA >20 ng/mL and the evidence of SVI at MRI were independent predictors of LNI. CONCLUSIONS: The direct comparison of the two nomograms showed that Briganti 2019 nomogram was no more accurate than Briganti 2012, and that the role of MRI and MRI TB may be negligible in the prediction of LNI. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e983 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicola Frego More articles by this author Paciotti Marco More articles by this author Davide Maffei More articles by this author Pier Paolo Avolio More articles by this author Roberto Contieri More articles by this author Alessandro Uleri More articles by this author Massimo Lazzeri More articles by this author Alberto Saita More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF DownloadLoading ...