PD61-03 EXTERNAL VALIDATION OF THE AVAILABLE NOMOGRAMS FOR THE IDENTIFICATION OF CANDIDATES FOR a STAGING EXTENDED PELVIC LYMPH NODE DISSECTION AT THE TIME OF RADICAL PROSTATECTOMY IN PROSTATE CANCER PATIENTS PREOPERATIVELY STAGED WITH PSMA PET

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD61)1 May 2024PD61-03 EXTERNAL VALIDATION OF THE AVAILABLE NOMOGRAMS FOR THE IDENTIFICATION OF CANDIDATES FOR a STAGING EXTENDED PELVIC LYMPH NODE DISSECTION AT THE TIME OF RADICAL PROSTATECTOMY IN PROSTATE CANCER PATIENTS PREOPERATIVELY STAGED WITH PSMA PET Francesco Barletta, Simone Scuderi, Lorenzo Bianchi, Daniele Robesti, Pawel Rajwa, Timo F. W. Soeterik, Dennie Meijer, Christopher Darr, Hongqian Guo, Fabio Zattoni, Wolfgang Fendler, Giancarlo Marra, Steven Joniau, Riccardo Schiavina, Agostino Mattei, Cristian Fiori, Francesco Porpiglia, Maria Picchio, Roderick van den Bergh, Shahrok Shariat, Arturo Chiti, Francesco Montorsi, Alberto Briganti, and Giorgio Gandaglia Francesco BarlettaFrancesco Barletta , Simone ScuderiSimone Scuderi , Lorenzo BianchiLorenzo Bianchi , Daniele RobestiDaniele Robesti , Pawel RajwaPawel Rajwa , Timo F. W. SoeterikTimo F. W. Soeterik , Dennie MeijerDennie Meijer , Christopher DarrChristopher Darr , Hongqian GuoHongqian Guo , Fabio ZattoniFabio Zattoni , Wolfgang FendlerWolfgang Fendler , Giancarlo MarraGiancarlo Marra , Steven JoniauSteven Joniau , Riccardo SchiavinaRiccardo Schiavina , Agostino MatteiAgostino Mattei , Cristian FioriCristian Fiori , Francesco PorpigliaFrancesco Porpiglia , Maria PicchioMaria Picchio , Roderick van den BerghRoderick van den Bergh , Shahrok ShariatShahrok Shariat , Arturo ChitiArturo Chiti , Francesco MontorsiFrancesco Montorsi , Alberto BrigantiAlberto Briganti , and Giorgio GandagliaGiorgio Gandaglia View All Author Informationhttps://doi.org/10.1097/01.JU.0001009352.31737.3d.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Available guidelines recommend performing extended pelvic lymph node dissection (ePLND) in radical prostatectomy (RP) prostate cancer (PCa) patients at higher risk of lymph node invasion (LNI) for staging purposes. Novel risk tools aimed at predicting LNI in men staged with PSMA-PET have been developed but not yet included in the guidelines. Here, we aim to externally validate available tools to predict LNI in men with a negative preoperative PSMA-PET (miN0). METHODS: A total of 267 miN0 PCa patients treated with RP and extended pelvic lymph node dissection (ePLND) at 9 referral centres between 2016-2023 were identified. Individual LNI risk was calculated relying on the coefficients of the MSKCC, Amsterdam-Brisbane-Sydney, Briganti 2012-2017-2019 and 2023 nomograms. The extent of over- or underestimation associated with their use was depicted using calibration plots. The discrimination of these models was quantified using the C-index. The net benefit was assessed using decision-curve analysis (DCA). We then assessed the number of LNI missed and the number of ePLND procedures avoided using a 5% threshold for each available tool. RESULTS: A total of 28 (10%) patients harbored LNI at final pathology. Overall, ISUP grade group distribution and MRI stage were as follows: 49 (18%) vs 48 (18%) vs 115 (43%) vs 55 (21%) for 1-2 vs 3 vs 4 vs 5; and 203 (76%) vs 47 (18%) vs 17 (6.4%) for organ-confined vs extracapsular- vs seminal vesicles-extension. The C-index for the MSKCC, Amsterdam-Brisbane-Sydney, Briganti 2012-2017-2019 and 2023 nomograms were 65, 67, 69, 64, 74 and 79%. While the MSKCC, Amsterdam-Brisbane-Sydney, Briganti 2012-2017-2019 nomograms were associated with a risk of overestimation, the Briganti 2023 nomogram exhibited optimal concordance at predicted risk of LNI ≤20%. At DCA, the Briganti 2023 nomogram exhibited higher net-benefit (Figure). Adoption of a 5% cut-off of the Briganti 2023 nomogram would have spared 120 (45%) ePLND with 4 (3%) LNI missed. CONCLUSIONS: The use of the recently proposed Briganti 2023 nomogram in miN0 patients is associated with a substantially higher number of ePLNDs spared with only 3% LNI missed. This model exhibited excellent discrimination, calibration and net benefit compared to available models at external validation. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1280 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Barletta More articles by this author Simone Scuderi More articles by this author Lorenzo Bianchi More articles by this author Daniele Robesti More articles by this author Pawel Rajwa More articles by this author Timo F. W. Soeterik More articles by this author Dennie Meijer More articles by this author Christopher Darr More articles by this author Hongqian Guo More articles by this author Fabio Zattoni More articles by this author Wolfgang Fendler More articles by this author Giancarlo Marra More articles by this author Steven Joniau More articles by this author Riccardo Schiavina More articles by this author Agostino Mattei More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Maria Picchio More articles by this author Roderick van den Bergh More articles by this author Shahrok Shariat More articles by this author Arturo Chiti More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF downloadLoading ...