Porcaro Antonio Benito, Panunzio Andrea, Orlando Rossella, Tafuri Alessandro, Gallina Sebastian, Bianchi Alberto, Serafin Emanuele, Mazzucato Giovanni, Montanaro Francesca, Baielli Alberto, Artoni Francesco, Ditonno Francesco, Roggero Luca, Franceschini Andrea, Boldini Michele, Treccani Lorenzo Pierangelo, Veccia Alessandro, Rizzetto Riccardo, Brunelli Matteo, De Marco Vincenzo, Siracusano Salvatore, Cerruto Maria Angela, Bertolo Riccardo, Antonelli Alessandro
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Department of Urology, Vito Fazzi Hospital, Lecce, Italy.
Arab J Urol. 2024 Apr 8;22(4):227-234. doi: 10.1080/20905998.2024.2339062. eCollection 2024.
We tested whether the 2012 Briganti nomogram for the risk of pelvic lymph node invasion (PLNI) may represent a predictor of disease progression after surgical management in high-risk (HR) prostate cancer (PCa) patients according to the European Association of Urology.
Between January 2013 and December 2021, HR PCa patients treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) were identified. The 2012 Briganti nomogram was evaluated as a continuous and categorical variable, which was dichotomized using the median. The risk of disease progression, defined as the event of biochemical recurrence and/or local recurrence/distant metastases was assessed by Cox regression models.
Overall, 204 patients were identified. The median 2012 Briganti nomogram score resulted 12.0% (IQR: 6.0-22.0%). PLNI was detected in 57 (27.9%) cases. Compared to patients who had preoperatively a 2012 Briganti nomogram score ≤12%, those with a score >12% were more likely to present with higher percentage of biopsy positive cores, palpable tumors at digital rectal examination, high-grade cancers at prostate biopsies, and unfavorable pathology in the surgical specimen. At multivariable Cox regression analyses, disease progression, which occurred in 85 (41.7%) patients, was predicted by the 2012 Briganti nomogram score (HR: 1.02; 95%CI: 1.00-1.03; = 0.012), independently by tumors presenting as palpable (HR: 1.78; 95%CI: 1.10.2.88; = 0.020) or the presence of PLNI in the surgical specimen (HR: 3.73; 95%CI: 2.10-5.13; = 0.012).
The 2012 Briganti nomogram represented an independent predictor of adverse prognosis in HR PCa patients treated with RARP and ePLND. As the score increased, so patients were more likely to experience disease progression, independently by the occurrence of PLNI. The association between the nomogram, unfavorable pathology and tumor behavior might turn out to be useful for selecting a subset of patients needing different treatment paradigms in HR disease.
根据欧洲泌尿外科学会的标准，我们测试了2012年Briganti列线图用于预测高危（HR）前列腺癌（PCa）患者手术治疗后疾病进展的情况，该列线图用于评估盆腔淋巴结侵犯（PLNI）风险。
确定2013年1月至2021年12月期间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HR PCa患者。将2012年Briganti列线图评估为连续和分类变量，并使用中位数进行二分法划分。通过Cox回归模型评估疾病进展风险，疾病进展定义为生化复发和/或局部复发/远处转移事件。
总共确定了204例患者。2012年Briganti列线图评分中位数为12.0%（四分位间距：6.0 - 22.0%）。57例（27.9%）检测到PLNI。与术前2012年Briganti列线图评分≤12%的患者相比，评分>12%的患者活检阳性核心比例更高、直肠指检可触及肿瘤、前列腺活检为高级别癌症以及手术标本病理结果不佳的可能性更大。在多变量Cox回归分析中，85例（41.7%）患者出现疾病进展，2012年Briganti列线图评分可预测疾病进展（风险比：1.02；95%置信区间：1.00 - 1.03；P = 0.012），独立于可触及的肿瘤（风险比：1.78；95%置信区间：1.10 - 2.88；P = 0.020）或手术标本中存在PLNI（风险比：3.73；95%置信区间：2.10 - 5.13；P = 0.012）。
2012年Briganti列线图是接受RARP和ePLND治疗的HR PCa患者不良预后的独立预测指标。随着评分增加，患者疾病进展的可能性更大，且独立于PLNI的发生情况。列线图、不良病理与肿瘤行为之间的关联可能有助于在HR疾病中选择需要不同治疗模式的患者亚组。
