Objective

To validate a nomogram predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy taking into consideration multiparametric-magnetic resonance imaging (mp-MRI) parameters and targeted biopsies in a western European cohort.

Patients and Methods

A total of 473 men diagnosed by targeted biopsies, using software-based MRI-ultrasound image fusion system, and operated by radical prostatectomy with extended pelvic lymph node dissection across 11 Europeans centers between 2012 and 2019 were identified. Area under the curve of the receiver operator characteristic curve, calibration plot and decision curve analysis were used to evaluated the performance of the model.

Results

Overall, 56 (11.8%) patients had LNI on final pathologic examination with a median (IQR) of 13 (9–18) resected nodes. Significant differences (all P < 0.05) were found between patients with and without LNI in terms of preoperative PSA, clinical stage at DRE and mp-MRI, maximum diameter of the index lesion, PI-RADS score, Grade Group on systematic and targeted biopsies, total number of dissected lymph nodes, final pathologic staging and Grade Group. External validation of the prediction model showed a good accuracy with an area under the curve calculated as 0.8 (CI 95% 0.75–0.86). Graphic analysis of calibration plot and decision curve analysis showed a slight underestimation for predictive probability for LNI between 3% and 22% and a high net benefit. A cut-off at 7% was associated with a risk of missing LNI in 2.6%, avoiding unnecessary surgeries in 55.9%.

Conclusions

We report an external validation of the nomogram predicting LNI in patients treated with extended pelvic lymph node dissection in a western European cohort and a cut-off at 7% seems appropriate.

中文翻译：

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Briganti 列线图预测经磁共振成像靶向和系统活检诊断出的中高危前列腺癌患者的淋巴结浸润的外部验证：一项欧洲多中心研究。

客观的

考虑多参数磁共振成像 (mp-MRI) 参数和西欧队列中的靶向活检，验证列线图预测接受根治性前列腺切除术的前列腺癌患者的淋巴结浸润 (LNI)。

患者和方法

2012 年至 2019 年间，共有 473 名男性通过靶向活检诊断，使用基于软件的 MRI-超声图像融合系统，并通过根治性前列腺切除术和扩大盆腔淋巴结清扫术在 11 个欧洲中心进行了手术。接受者操作特征曲线的曲线下面积、校准图和决策曲线分析用于评估模型的性能。

结果

总体而言，56 名 (11.8%) 患者在最终病理检查中出现 LNI，切除的淋巴结中位数 (IQR) 为 13 (9-18) 个。显着差异（所有P< 0.05) 在术前 PSA、DRE 和 mp-MRI 的临床分期、指标病变的最大直径、PI-RADS 评分、系统和靶向活检的等级组、解剖总数方面发现 LNI 患者之间的差异淋巴结、最终病理分期和分级组。预测模型的外部验证显示出良好的准确性，曲线下面积计算为 0.8 (CI 95% 0.75–0.86)。校准图和决策曲线分析的图形分析显示，LNI 的预测概率在 3% 至 22% 之间略有低估，并且净收益较高。7% 的临界值与 2.6% 的 LNI 缺失风险相关，避免了 55.9% 的不必要手术。

结论

我们报告了对西欧队列中接受扩大盆腔淋巴结清扫术治疗的患者的列线图预测 LNI 的外部验证，7​​% 的临界值似乎是合适的。