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Beitragstitel A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies
Beitragscode P003
Autor:innen
  1. Giorgio Gandaglia Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
  2. Guillaume Ploussard Saint Jean Languedoc/La Croix du Sud Hospital
  3. Massimo Valerio CHUV-Lausanne University Hospital
  4. Agostino Mattei Luzerner Kantonsspital
  5. Cristian Fiori San Luigi Gonzaga Hospital, Orbassano
  6. Nicola Fossati Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
  7. Armando Stabile Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
  8. Jean-Baptiste Beauval CHU Rangueil
  9. Bernard Malavaud CHU Rangueil
  10. Mathieu Roumiguié CHU Rangueil
  11. Daniele Robesti Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
  12. Paolo Dell'Oglio Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
  13. Marco Moschini Luzerner Kantonsspital
  14. Stefania Zamboni Luzerner Kantonsspital
  15. Arnas Rakauskas CHUV-Lausanne University Hospital
  16. Frédéric Bacchetta CHUV Präsentierende:r
  17. Francesco De Cobelli Experimental Imaging Center, IRCCS Ospedale San Raffaele
  18. Francesco Porpiglia San Luigi Gonzaga Hospital, Orbassano
  19. Francesco Montorsi Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
  20. Alberto Briganti Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute
Präsentationsform Freie Mitteilungen
Themengebiete
  • Prostata
Abstract-Text Background and objectives
Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies. The objective was to assess the accuracy of available tools to predict LNI and to develop a novel model for men diagnosed via MRI-targeted biopsies.
Design, setting, and participants
A total of 497 patients diagnosed via MRI-targeted biopsies and treated with RP and extended pelvic lymph node dissection (ePLND) at five institutions were retrospectively identified. Three available models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analyses. A nomogram predicting LNI was developed and internally validated.
Results and limitations
Overall, 62 patients (12.5%) had LNI. The median number of nodes removed was 15. The AUC for the Briganti 2012, Briganti 2017, and MSKCC nomograms was 82%, 82%, and 81%, respectively, and their calibration characteristics were suboptimal. A model including PSA, clinical stage and maximum diameter of the index lesion on multiparametric MRI (mpMRI), grade group on targeted biopsy, and the presence of clinically significant PCa on concomitant systematic biopsy had an AUC of 86% and represented the basis for a coefficient-based nomogram. This tool exhibited a higher AUC and higher net benefit compared to available models developed using standard biopsies. Using a cutoff of 7%, 244 ePLNDs (57%) would be spared and a lower number of LNIs would be missed compared to available nomograms (1.6% vs 4.6% vs 4.5% vs 4.2% for the new nomogram vs Briganti 2012 vs Briganti 2017 vs MSKCC).
Conclusions
Available models predicting LNI are characterized by suboptimal accuracy and clinical net benefit for patients diagnosed via MRI-targeted biopsies. A novel nomogram including mpMRI and MRI-targeted biopsy data should be used to identify candidates for ePLND in this setting. We developed the first nomogram to predict lymph node invasion (LNI) in prostate cancer patients diagnosed via magnetic resonance imaging-targeted biopsy undergoing radical prostatectomy. Adoption of this model to identify candidates for extended pelvic lymph node dissection could avoid up to 60% of these procedures at the cost of missing only 1.6% patients with LNI.