Yonsei nomogram to predict lymph node invasion in Asian men with prostate cancer during robotic era

Authors


Abstract

Objective

  • To develop a novel nomogram to predict lymph node invasion (LNI) in Asian men undergoing radical prostatectomy (RP) and pelvic LN dissection (PLND) for localised prostate cancer.

Patients and Methods

  • The patient cohort included 541 patients who underwent robot-assisted RP and PLND by a single surgeon between January 2008 and December 2011.
  • Patients with dissection of <10 LNs, prostate-specific antigen (PSA) levels of >50 ng/mL, incomplete biopsy data, and treatment with neoadjuvant therapy were excluded.

Results

  • The median (interquartile range) number of LNs removed was 17 (14–22) and 45 patients (8.3%) had LN metastases.
  • On multivariate logistic regression analysis, PSA level, clinical stage and Gleason score were independent predictors of LNI.
  • The bootstrap corrected area under curve of the model incorporating PSA level, clinical stage, and biopsy Gleason score was 0.883.
  • With a cutoff value of 4%, PLND could be omitted in 326 patients (60.2%), missing only two patients (4.4%) with LNI. The sensitivity, specificity, positive predictive value and negative predictive value were 95.6%, 65.3%, 20.0% and 99.4%, respectively.

Conclusions

  • We report a nomogram to predict LNI in Asian men with prostate cancer. The model demonstrated high accuracy and could be used for counselling patients and the selection of candidates for PLND.

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