The 2019 Briganti nomogram was developed to calculate the risk of lymph node invasion (LNI) and identify prostate cancer (PCa) patients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy who should be considered for an extended pelvic lymph node dissection (ePLND). Since its implementation is still limited by lack of a formal external validation, we aimed to validate this tool in a large contemporary cohort. We identified 487 patients diagnosed using MRI-targeted with concomitant systematic biopsy who underwent radical prostatectomy (RP) and an anatomically defined ePLND at six centers. The external validity of the 2019 Briganti nomogram for estimating LNI risk was assessed via calibration, discrimination, and decision curve analyses (DCAs). A total of 38 (8%) patients had LNI at final pathology. The median number of nodes removed was 18 (interquartile range 14–24). On external validation, the 2019 Briganti nomogram had an area under the receiver operating characteristic curve (AUC) of 79%. Although there was some miscalibration, this was at predicted probabilities >35% and therefore outside the clinically relevant range. DCA demonstrated that the 2019 Briganti nomogram improved clinical risk prediction against LNI threshold probabilities of ≤30%. For a 7% cutoff, 273 (56%) ePLNDs would be spared and only 2.6% LNIs would be missed. The 2019 Briganti nomogram was characterized by higher AUC compared to the 2012 and 2017 Briganti nomograms and the Memorial Sloan Kettering Cancer Center risk calculator (79% vs 75% vs 65% vs 74%) and demonstrated the highest net benefit on DCA. This first multi-institutional validation of the 2019 Briganti nomogram in predicting LNI in PCa patients diagnosed with MRI-targeted biopsy confirms the highest AUC, better calibration and the highest net benefit compared with available tools and should be adopted to identify candidates for ePLND among men diagnosed with MRI-targeted biopsy.

Patient summary

We performed the first multi-institutional validation of the first nomogram predicting lymph node invasion specifically developed using data from prostate cancer patients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy. This nomogram exhibited excellent characteristics on external validation compared with available tools and should be adopted to identify candidates for extended pelvic lymph node dissection among men diagnosed with MRI-targeted biopsy.

中文翻译：

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2019 Briganti Nomogram的外部验证可用于确定应考虑进行盆腔淋巴结扩大切除的前列腺癌患者。

2019年Briganti列线图的开发是为了计算淋巴结浸润（LNI）的风险，并确定诊断为以磁共振成像（MRI）为目标的活检诊断为前列腺癌（PCa）的患者，应考虑行盆腔淋巴结清扫术（ePLND）扩大。由于仍缺乏正式的外部验证，因此其实施仍然受到限制，因此我们旨在通过大规模的现代队列验证此工具。我们确定了487例经MRI确诊并伴有系统活检的患者，在六个中心接受了根治性前列腺切除术（RP）和解剖学定义的ePLND。通过校准，判别和决策曲线分析（DCA）评估了2019年Briganti诺模图估计LNI风险的外部有效性。最终病理中共有38名（8％）患者患有LNI。删除的节点的中位数为18（四分位间距14-24）。在外部验证中，2019年的Briganti列线图在接收器工作特性曲线（AUC）下的面积为79％。尽管存在一些校准错误，但这是在预计概率> 35％的情况下，因此不在临床相关范围内。DCA证明，2019年的Briganti列线图改进了针对LNI阈值概率≤30％的临床风险预测。截止到7％，将免除273个（56％）ePLND，仅错过了2.6％的LNI。与2012年和2017年的Briganti nomograms和Memorial Sloan Kettering癌症中心风险计算器相比，2019年的Briganti nomogram具有更高的AUC（79％vs 75％vs 65％vs 74％），并显示了DCA的最高净收益。

病人总结

我们使用预测来自淋巴结侵袭的第一个诺模图进行了首次多机构验证，该诺模图是使用诊断为以磁共振成像（MRI）为目标的活检诊断为前列腺癌的患者的数据专门开发的。与可使用的工具相比，该诺模图在外部验证方面表现出出色的特征，应被用来确定诊断为MRI靶向活检的男性中扩大盆腔淋巴结清扫的候选人。