Małkiewicz Bartosz, Ptaszkowski Kuba, Knecht Klaudia, Gurwin Adam, Wilk Karol, Kiełb Paweł, Dudek Krzysztof, Zdrojowy Romuald
Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland.
Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland.
Life (Basel). 2021 May 25;11(6):479. doi: 10.3390/life11060479.
(1) Introduction: The study aimed to test and validate the performance of the 2012 Briganti nomogram as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with extended pelvic lymph node dissection (PLND) to examine their performance and to analyse the therapeutic impact of using a different nomogram cut-off. (2) Material and Methods: The study group consisted of 222 men with clinically localized prostate cancer (PCa) who underwent RP with ePLND between 01/2012 and 10/2018. Measurements included: preoperative PSA, clinical stage (CS), primary and secondary biopsy Gleason pattern, and the percentage of positive cores. The area under the curve (AUC) of the receiver operator characteristic analysis was appointed to quantify the accuracy of the primary nomogram model to predict LNI. The extent of estimation associated with the use of this model was graphically depicted using calibration plots. (3) Results: The median number of removed lymph nodes was 16 (IQR 12-21). A total of 53 of 222 patients (23.9%) had LNI. Preoperative clinical and biopsy characteristics differed significantly (all < 0.005) between men with and without LNI. A nomogram-derived cut-off of 7% could lead to a reduction of 43% (95/222) of lymph node dissection while omitting 19% (10/53) of patients with LNI. The sensitivity, specificity, and negative predictive value associated with the 7% cut-off were 81.1%, 50.3%, and 96.3%, respectively. (4) Conclusions: The analysed nomogram demonstrated high accuracy for LNI prediction. A nomogram-derived cut-off of 7% confirmed good performance characteristics within the first external validation cohort from Poland.
(1) 引言：本研究旨在测试并验证2012年布里甘蒂列线图作为接受根治性前列腺切除术（RP）并扩大盆腔淋巴结清扫术（PLND）的男性盆腔淋巴结转移（LNI）预测指标的性能，以评估其性能，并分析使用不同列线图临界值的治疗影响。(2) 材料与方法：研究组由222例临床局限性前列腺癌（PCa）男性患者组成，他们于2012年1月至2018年10月期间接受了RP联合ePLND。测量指标包括：术前前列腺特异抗原（PSA）、临床分期（CS）、初次和二次活检的 Gleason 分级模式以及阳性活检芯的百分比。采用受试者工作特征分析的曲线下面积（AUC）来量化原始列线图模型预测LNI的准确性。使用校准图以图形方式描绘使用该模型时的估计范围。(3) 结果：切除淋巴结的中位数为16个（四分位间距12 - 21个）。222例患者中有53例（23.9%）发生LNI。有LNI和无LNI的男性患者术前临床和活检特征存在显著差异（均P < 0.005）。列线图得出的7%临界值可使淋巴结清扫减少43%（95/222），同时遗漏19%（10/53）的LNI患者。与7%临界值相关的灵敏度、特异度和阴性预测值分别为分别为81.1%、50.3%和96.3%。(4) 结论：所分析的列线图在预测LNI方面显示出较高的准确性。列线图得出的7%临界值在波兰首个外部验证队列中证实了良好的性能特征。
