The Briganti nomogram can be used with a threshold of 5% to decide when to offer lymph node dissection during radical prostatectomy. The objective of the study was to assess the accuracy of the Briganti nomogram on intermediate-risk prostate cancer patients managed in a single academic department.
We retrospectively reviewed the files of all patients managed by radical prostatectomy (RP) and bilateral pelvic lymph node dissection (BPLND) in our center between 2005 and 2017. The overall accuracy of the model in predicting metastatic lymph node disease was quantified by the construction of a receiver-operator characteristic (ROC) curve. A calibration plot was drawn to represent the relationship between the predicted and observed frequencies.
We included 285 patients, among whom 175 (61.4%) were classified as intermediate risk as defined by D'Amico. The median follow-up was 60 (34-93) months. Twenty-seven patients (9.5%) were diagnosed with lymph node metastases. The median number of lymph nodes removed was 10 (7-14). The mean Briganti score was 19.3% in patients with lymph node involvement (LNI) and 6.3% in patients without LNI. Focusing on intermediate-risk patients, 91(52%) and 84 (48%) had a Briganti score < 5% and ≥ 5%, respectively, among whom 6 (6.6%) and 7(8.3%) had lymph node metastases. The accuracy of the score was low for intermediate risk patients with an area under the curve (AUC) of 53.1% (95% CI 0.45-0.61).
The Briganti nomogram in our retrospective cohort showed low accuracy for the prediction of lymph node involvement in an intermediate-risk prostate cancer population.
World journal of urology. 2020 Jun 24 [Epub ahead of print]
Nicolas Peilleron, Arnaud Seigneurin, Caroline Herault, Camille Verry, Michel Bolla, Jean-Jacques Rambeaud, Jean-Luc Descotes, Jean-Alexandre Long, Gaelle Fiard
Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France., Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC IMAG, Grenoble, France., Department of Medical Assessment, Grenoble Alpes University Hospital, Grenoble, France., Department of Radiotherapy, Grenoble Alpes University Hospital, Grenoble, France., Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France. .