Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy.
Eur Urol Focus. 2019 May;5(3):449-456. doi: 10.1016/j.euf.2017.11.013. Epub 2017 Dec 14.
Four nomograms are available for the prediction of lymph node invasion (LNI) prior to radical prostatectomy (RP): the Cagiannos, the 2012-Briganti, the Godoy, and the online-Memorial Sloan Kettering Cancer Center (MSKCC). None was tested in African Americans (AAs).
To perform a validation and head-to-head comparison of four nomograms for the prediction of LNI in AAs.
DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance Epidemiology and End Results database (2010-2014), we identified 14 077 Caucasians and 2668 AAs with clinically localised prostate cancer.
RP and pelvic lymph node dissection (PLND).
Predicted and observed LNI rates for the four nomograms were tested between AAs and Caucasians with Heagerty's concordance index (C-index), calibration plots, decision curve analyses (DCAs), and nomogram-derived cut-offs for avoided PLND and missed LNI cases.
All C-index values were lower in AAs than in Caucasians: Cagiannos (76.1% vs 79.5%), Godoy (73.0% vs 79.4%), 2012-Briganti (73.3% vs 81.3%), and MSKCC (72.6% vs 81.6%). All four nomogram calibration plots showed invariably worse performances in AAs. In DCAs focusing on AAs, the Cagiannos nomogram provided the highest net benefit relative to the remaining three nomograms. In nomogram cut-off analyses testing the number of avoided PLND against the number of missed LNI cases, the Cagiannos nomogram yielded the best results when tested in AAs. However, in DCAs and cut-off analyses that compared AAs with Caucasians, AAs yielded less favourable outcomes regardless of which nomogram was tested. We lack a central pathology review and standardisation of PLND templates.
In AAs, the Cagiannos nomogram provides the optimal results relative to the remaining three nomograms. Nonetheless, all tested nomograms yielded worse metrics in AAs than in Caucasians.
All four tested nomograms can be equally considered in Caucasians. Conversely, the Cagiannos nomogram should be preferred in African Americans.
在根治性前列腺切除术（RP）前预测淋巴结侵犯（LNI），有四种列线图可供使用：Cagiannos、2012-Briganti、Godoy 和在线 Memorial Sloan Kettering 癌症中心（MSKCC）。这些都没有在非裔美国人（AA）中进行测试。
对四种预测 AA 中 LNI 的列线图进行验证和头对头比较。
设计、设置和参与者：在 Surveillance Epidemiology and End Results 数据库（2010-2014 年）中，我们确定了 14077 名白人和 2668 名 AA 患有临床局限性前列腺癌。
RP 和盆腔淋巴结清扫术（PLND）。
通过 Heagerty 一致性指数（C-index）、校准图、决策曲线分析（DCA）以及为避免 PLND 和漏诊 LNI 病例而制定的列线图截断值，在 AA 和白人之间测试了四种列线图的预测和观察到的 LNI 率。
AA 的所有 C-index 值均低于白人：Cagiannos（76.1%比 79.5%）、Godoy（73.0%比 79.4%）、2012-Briganti（73.3%比 81.3%）和 MSKCC（72.6%比 81.6%）。所有四个列线图的校准图在 AA 中表现均较差。在侧重于 AA 的 DCA 中，Cagiannos 列线图与其他三个列线图相比提供了更高的净效益。在测试避免 PLND 的数量与漏诊 LNI 病例的数量的列线图截断值分析中，Cagiannos 列线图在 AA 中产生了最佳结果。然而，在 DCA 和比较 AA 和白人的列线图截断值分析中，无论测试哪个列线图，AA 的结果都不太有利。我们缺乏中央病理审查和 PLND 模板的标准化。
在 AA 中，与其他三个列线图相比，Cagiannos 列线图提供了最佳结果。尽管如此，所有测试的列线图在 AA 中的指标均劣于白人。
在白人中，这四个测试的列线图可以同等考虑。相反，在非裔美国人中，应该首选 Cagiannos 列线图。
