Our aim was to validate Briganti's nomograms predicting the probability of lymph node involvement (LNI) in prostate cancer (PCa). Clinicopathological data of 256 PCa patients who underwent extended pelvic lymph node dissection (ePLND) and radical prostatectomy (RP) were obtained from two Bulgarian institutions. Predicted probabilities of LNI were assessed using Briganti's nomograms based on ePLND. In addition to the established basic LNI predictors, Briganti's nomograms included the number of lymph nodes removed (version 2006) and the number and percentage of positive biopsy cores (versions 2007 and 2012). The accuracy of these nomograms was compared with the updated Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram (version 2011). Receiver-operating characteristics analysis was done to assess the discriminative ability of each of the nomograms applied. All of Briganti's nomograms showed a higher predictive accuracy as compared with the updated MSKCC nomogram. The respective AUC values were calculated as 0.847, 0.837, 0.858 and 0.875 for the four Briganti nomograms, and 0.770 for the updated MSKCC nomogram, respectively. Despite the potential for heterogeneity in patient selection and management, all predictions demonstrated high concordance with actual observations. Compared with other similar prognostic tools the updated Briganti nomogram (version 2012) showed the highest predictive accuracy and should therefore be preferred.

Keywords:
Prostate cancer, Extended pelvic lymph node dissection, Lymph node involvement, Nomograms, Validation
1.
Partin AW, Yoo J, Carter HB, et al: The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol 1993;150:110-114.
2.
Eifler JB, Feng Z, Lin BM, et al: An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 2013;111:22-29.
3.
Katz MS, Efstathiou JA, D'Amico AV, et al: The ‘CaP calculator': an online decision support tool for clinically localized prostate cancer. BJU Int 2010;105:1417-1422.
4.
Briganti A, Larcher A, Abdollah F, et al: Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 2012;61:480-487.
5.
Cagiannos I, Karakiewicz P, Eastham JA, et al: A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol 2003;170:1798-1803.
6.
Briganti A, Chun FK, Salonia A, et al: Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer. BJU Int 2006;98:788-793.
7.
Briganti A, Karakiewicz PI, Chun FK, et al: Percentage of positive biopsy cores can improve the ability to predict lymph node invasion in patients undergoing radical prostatectomy and extended pelvic lymph node dissection. Eur Urol 2007;51:1573-1581.
8.
Makarov DV, Trock BJ, Humphreys EB, et al: Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology 2007;69:1095-1101.
9.
Godoy G, Chong KT, Cronin A, et al: Extent of pelvic lymph node dissection and the impact of standard template dissection on nomogram prediction of lymph node involvement. Eur Urol 2011;60:195-201.
10.
Huang Y, Isharwal S, Haese A, et al: Prediction of patient-specific risk and percentile cohort risk of pathological stage outcome using continuous prostate-specific antigen measurement, clinical stage and biopsy Gleason score. BJU Int 2011;107:1562-1569.
11.
Heidenreich A, Bastian PJ, Bellmunt J, et al: Guidelines on Prostate Cancer. EAU 2013. Available at: http://www.uroweb.org/gls/pdf/09_Prostate_Cancer_LR.pdf.
12.
Shariat SF, Karakiewicz PI, Roehrborn CG, Kattan MW: An updated catalog of prostate cancer predictive tools. Cancer 2008;113:3075-3099.
13.
Hinev AI, Anakievski D, Kolev N, Marianovski V, Hadjiev V: Validation of pre- and postoperative nomograms used to predict the pathological stage and prostate cancer recurrence after radical prostatectomy: a multi-institutional study. J BUON 2011;16:316-322.
14.
Hinev AI, Hadjiev V, Kolev N: Validation of preoperative nomograms predicting lymph node involvement in prostate cancer: a bi-institutional study. Eur Urol 2011;60:1310-1311.
15.
Hinev AI, Klissarova AD, Ghenev PI, et al: Radioisotopic detection of sentinel lymph nodes in clinically localized high-risk prostate cancer. J BUON 2009;14:661-667.
16.
Gleason DF: Histologic grading and clinical stage of prostatic carcinoma; in Tannenbaum M (ed): Urologic Pathology: The Prostate. Philadelphia, Lea & Ferbirger, 1997, pp 171.
17.
Schroeder FH, Hermanek P, Denis L, et al: The TNM classification of prostate cancer. Prostate Suppl 1992;4:129-138.
18.
Xiao WJ, Ye DW, Yao XD, Zhang SL, Dai B: Comparison of three versions of Partin tables to predict final pathologic stage in a Chinese cohort: a decision curve analysis. Urol Int 2013;91:69-74.
19.
Heidenreich A, Pfister D, Thüer D, Brehmer B: Percentage of positive biopsies predicts lymph node involvement in men with low-risk prostate cancer undergoing radical prostatectomy and extended pelvic lymphadenectomy. BJU Int 2011;107:220-225.
20.
Gacci M, Schiavina R, Lanciotti M, et al: External validation of the updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection. Urol Int 2013;90:277-282.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.