Pd45-07 External Validation of the Amsterdam-Brisbane-Sydney Nomogram for the Prediction of Lymph Node Invasion in Prostate Cancer Patients Subjected to Radical Prostatectomy and Concomitant Lymph Node Dissection

You have accessJournal of UrologyProstate Cancer: Staging II (PD45)1 May 2024PD45-07 EXTERNAL VALIDATION OF THE AMSTERDAM-BRISBANE-SYDNEY NOMOGRAM FOR THE PREDICTION OF LYMPH NODE INVASION IN PROSTATE CANCER PATIENTS SUBJECTED TO RADICAL PROSTATECTOMY AND CONCOMITANT LYMPH NODE DISSECTION Federica Sordelli, Nicola Frego, Vittorio Fasulo, Paola Arena, Edoardo Beatrici, Giuseppe Chiarelli, Giuseppe Garofano, Stefano Mancon, Fabio De Carne, Marco Paciotti, Andrea Piccolini, Filippo Dagnino, Alberto Saita, Massimo Lazzeri, Nicolò Maria Buffi, Paolo Casale, and Giovanni Lughezzani Federica SordelliFederica Sordelli , Nicola FregoNicola Frego , Vittorio FasuloVittorio Fasulo , Paola ArenaPaola Arena , Edoardo BeatriciEdoardo Beatrici , Giuseppe ChiarelliGiuseppe Chiarelli , Giuseppe GarofanoGiuseppe Garofano , Stefano ManconStefano Mancon , Fabio De CarneFabio De Carne , Marco PaciottiMarco Paciotti , Andrea PiccoliniAndrea Piccolini , Filippo DagninoFilippo Dagnino , Alberto SaitaAlberto Saita , Massimo LazzeriMassimo Lazzeri , Nicolò Maria BuffiNicolò Maria Buffi , Paolo CasalePaolo Casale , and Giovanni LughezzaniGiovanni Lughezzani View All Author Informationhttps://doi.org/10.1097/01.JU.0001008792.09108.b4.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend performing an extended Pelvic Lymph-Node Dissection (ePLND) in Prostate Cancer (PCa) patients with a significant risk of Lymph-Node Invasion (LNI) according to validated nomograms. Recently, the novel Amsterdam-Brisbane-Sydney nomogram has been published, incorporating clinical, biopsy, multiparametric magnetic resonance imaging (mpMRI), and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) data, to aid in the decision whether to perform or not ePLND. The aim of the study is to validate the Amsterdam-Brisbane-Sydney nomogram in an external cohort of contemporary PCa patients. METHODS: We retrospectively identified patients treated with Robot-Assisted Radical Prostatectomy (RARP)+ePLND at our tertiary center, between November 2020 and January 2023. Pre-operative data included total PSA, biopsy Gleason grade group (GGG), biopsy technique from which the highest GGG was derived, percentage of systematic cores with clinically significant PCa (csPCa; biopsy GGG≥2), mpMRI T stage, and evidence of lymph-node invasion on PSMA-PET (miN0/miN1). A multivariable logistic regression analysis was performed using the regression coefficient of the original model. The accuracy of the model was evaluated through the Area Under the Curve (AUC) of the Receiver Operator Characteristics (ROC) curve. Calibration plot was used to evaluate the extend of over and under-estimation of the model. RESULTS: We analyzed data from 216 intermediate- and high-risk PCa patients. Overall, 17 (7.9%) and 26 (12%) patients had evidence of miN1 and pN1, respectively. Initial PSA value, biopsy GGG, percentage of systematic cores with csPCa, mpMRI T stage and PSMA-PET findings were significantly different between patients with pN0 and pN1 (all p<0.05). In our external cohort, the Amsterdam-Brisbane-Sydney nomogram predicted the presence of LNI with an accuracy similar to that found by the authors (AUC 0.77 vs. 0.81). The calibration plot showed a good correlation between the predicted probabilities and the observed frequencies of LNI, with a slightly tendency to underestimation. Using a cut-off of 10%, ePLND could be omitted in 39 patients (18%), missing 2 pN1 cases (5.1%). CONCLUSIONS: We externally validated the Amsterdam-Brisbane-Sidney nomogram finding a comparable accuracy to that of the original cohort. The novel nomogram emphasizes the role of PSMA-PET in pre-operative staging for intermediate- and high-risk PCa, sparing most patients from unnecessary ePLND, with minimal risk of missing pN1 disease. Further studies and comparison with other models are needed to confirm the role of this model in the clinical practice. Source of Funding: No © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e970 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Federica Sordelli More articles by this author Nicola Frego More articles by this author Vittorio Fasulo More articles by this author Paola Arena More articles by this author Edoardo Beatrici More articles by this author Giuseppe Chiarelli More articles by this author Giuseppe Garofano More articles by this author Stefano Mancon More articles by this author Fabio De Carne More articles by this author Marco Paciotti More articles by this author Andrea Piccolini More articles by this author Filippo Dagnino More articles by this author Alberto Saita More articles by this author Massimo Lazzeri More articles by this author Nicolò Maria Buffi More articles by this author Paolo Casale More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...