Frego Nicola, Paciotti Marco, Buffi Nicolò Maria, Maffei Davide, Contieri Roberto, Avolio Pier Paolo, Fasulo Vittorio, Uleri Alessandro, Lazzeri Massimo, Hurle Rodolfo, Saita Alberto, Guazzoni Giorgio Ferruccio, Casale Paolo, Lughezzani Giovanni
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.
Front Surg. 2022 Feb 25;9:829515. doi: 10.3389/fsurg.2022.829515. eCollection 2022.
To externally validate and directly compare the performance of the Briganti 2012 and Briganti 2019 nomograms as predictors of lymph node invasion (LNI) in a cohort of patients treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND).
After the exclusion of patients with incomplete biopsy, imaging, or clinical data, 752 patients who underwent RARP and ePLND between December 2014 to August 2021 at our center, were included. Among these patients, 327 (43.5%) had undergone multi-parametric MRI (mpMRI) and mpMRI-targeted biopsy. The preoperative risk of LNI was calculated for all patients using the Briganti 2012 nomogram, while the Briganti 2019 nomogram was used only in patients who had performed mpMRI with the combination of targeted and systematic biopsy. The performances of Briganti 2012 and 2019 models were evaluated using the area under the receiver-operating characteristics curve analysis, calibrations plot, and decision curve analysis.
A median of 13 (IQR 9-18) nodes per patient was removed, and 78 (10.4%) patients had LNI at final pathology. The area under the curves (AUCs) for Briganti 2012 and 2019 were 0.84 and 0.82, respectively. The calibration plots showed a good correlation between the predicted probabilities and the observed proportion of LNI for both models, with a slight tendency to underestimation. The decision curve analysis (DCA) of the two models was similar, with a slightly higher net benefit for Briganti 2012 nomogram. In patients receiving both systematic- and targeted-biopsy, the Briganti 2012 accuracy was 0.85, and no significant difference was found between the AUCs of 2012 and 2019 nomograms ( = 0.296). In the sub-cohort of 518 (68.9%) intermediate-risk PCa patients, the Briganti 2012 nomogram outperforms the 2019 model in terms of accuracy (0.82 vs. 0.77), calibration curve, and net benefit at DCA.
The direct comparison of the two nomograms showed that the most updated nomogram, which included MRI and MRI-targeted biopsy data, was not significantly more accurate than the 2012 model in the prediction of LNI, suggesting a negligible role of mpMRI in the current population.
对外验证并直接比较Briganti 2012年和Briganti 2019年列线图在接受机器人辅助根治性前列腺切除术（RARP）和扩大盆腔淋巴结清扫术（ePLND）的患者队列中作为淋巴结侵犯（LNI）预测指标的性能。
排除活检、影像学或临床数据不完整的患者后，纳入了2014年12月至2021年8月在本中心接受RARP和ePLND的752例患者。在这些患者中，327例（43.5%）接受了多参数MRI（mpMRI）及mpMRI靶向活检。使用Briganti 2012年列线图计算所有患者术前LNI风险，而Briganti 2019年列线图仅用于接受了mpMRI联合靶向及系统活检的患者。采用受试者操作特征曲线下面积分析、校准图和决策曲线分析评估Briganti 2012年和2019年模型的性能。
每位患者平均切除13个（四分位间距9 - 18个）淋巴结，78例（10.4%）患者最终病理检查发现有LNI。Briganti 2012年和2019年列线图的曲线下面积（AUC）分别为0.84和0.82。校准图显示两个模型预测概率与观察到的LNI比例之间具有良好相关性，均有轻微低估趋势。两个模型的决策曲线分析（DCA）相似，Briganti 2012年列线图的净效益略高。在接受系统活检和靶向活检的患者中，Briganti 2012年列线图的准确率为0.85，2012年和2019年列线图的AUC之间无显著差异（P = 0.296）。在518例（68.9%）中危前列腺癌患者亚组中，Briganti 2012年列线图在准确率（0.82对vs. 0.77）、校准曲线和DCA净效益方面优于2019年模型。
两种列线图的直接比较表明，包含MRI和MRI靶向活检数据的最新列线图在预测LNI方面并不比2012年模型显著更准确，提示mpMRI在当前人群中的作用可忽略不计。
