5 years ago

First North American validation and head-to-head comparison of four preoperative nomograms for prediction of lymph node invasion before radical prostatectomy

Fred Saad, Zhe Tian, Alberto Briganti, Firas Abdollah, Giorgio Gandaglia, Raisa S. Pompe, Pierre I. Karakiewicz, Shahrokh F. Shariat, Michele Marchioni, Markus Graefen, Nicola Fossati, Francesco Montorsi, Marco Bandini
Objectives To perform a head-to-head comparison of four nomograms, namely the Cagiannos, the 2012-Briganti, the Godoy and the online-Memorial Sloan Kettering Cancer Center (MSKCC), for prediction of lymph node invasion (LNI) in a North American population. Materials & Methods 19,775 clinically localized prostate cancer (PCa) patients underwent radical prostatectomy and pelvic lymph node dissection (PLND) were identified within the Surveillance Epidemiology and End Results (SEER) database. All four nomograms were tested with Heagerty's concordance index (C-index), calibration plots and decision curves analyses (DCA). Moreover, we examined specific nomogram derived cut-offs to compare the number of avoided PLNDs and missed LNI positive cases. Results All nomograms demonstrated highly comparable C-index value: the Cagiannos (78.6%), the Godoy (78.2%), the 2012-Briganti (79.8%) and the MSKCC (79.9%). The Cagiannos nomogram showed the best calibration, followed by the 2012-Briganti, the Godoy and the online-MSKCC. In DCA, the 2012-Briganti and the Cagiannos in that order provided the best results followed by the Godoy and the online-MSKCC models. For each nomogram, the cut-off associated with ≤10% missed LNI cases avoided 8,693 (46.6%), 8,652 (46.4%), 8,461 (45.4%) and 8,590 (46.1%) PLNDs for respectively the Cagiannos (2.6% cut-off), the online-MSKCC (4.3% cut-off), the Godoy (3.6% cut-off) and the 2012-Briganti (4.6% cut-off) nomograms. Conclusion The Cagiannos and the 2012-Briganti nomograms exhibited the best calibrations and DCA results. Conversely, C-index values and ability to avoid unnecessary PLND were virtually the same for all four examined nomograms. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.14074

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