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Prostate Cancer: Staging (MP11): Moderated Poster 11: Friday, September 10, 2021

MP11-20 A NEW NOMOGRAM TO IDENTIFY PATIENTS ELIGIBLE FOR EXTENDED PELVIC LYMPH-NODE DISSECTION DURING RADICAL PROSTATECTOMY ON THE BASIS OF TARGET BIOPSY FINDINGS ONLY

Checcucci, Enrico; Fiori, Cristian; Stura, Ilaria; Amparore, Daniele; De Cillis, Sabrina; Pecoraro, Angela; Alessio, Paolo; Piana, Alberto; Piramide, Federico; Volpi, Gabriele; Verri, Paolo; Granato, Stefano; Carbonaro, Beatrice; Zamengo, Davide; De Pascale, Agostino; Gned, Dario; Manfredi, Matteo; Migliaretti, Giuseppe; Porpiglia, Francesco

doi: 10.1097/JU.0000000000001984.20
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INTRODUCTION AND OBJECTIVE:

Nowadays, the role of synchronous pelvic extended lymphadenectomy (ePLND) during prostatectomy for prostate cancer still remains discussed. Various different tools aiming to identify patients who will benefit from ePLND are available such as mp-MRI. However, also other instruments such as nomograms, can help the surgeon during the decision-making process in case of positive target biopsy (TB) alone. The aim of our study was to develop a novel model based on mp-MRI findings and TB alone in order to predict the risk of Lymph Node Invasion (LNI).

METHODS:

We retrospectively extracted from our prospectively maintained database patients with preoperative positive mp-MRI and TB who underwent robotic prostatectomy with ePLND from April 2014 to March 2020. A logistic regression model was performed to evaluate the impact of pre- and intra-operative factors on the risk of LNI. The results are shown in terms of Odds Ratio (OR) with a 95% Confidence Interval (95%CI). Model discrimination was assessed using an area under curve (AUC), the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of LNI based on the logistic model was generated. The proposed model cut-off was chosen maximizing both sensitivity and Youden score.

RESULTS:

Overall, 461 patients were included in our study; among them 52 (11.27%) had LNI. At logistic regression DRE, MRI findings (organ confined vs ECE, vs SVI), PI-RADS, seminal vesicle invasion, PSA and worst GS at I and II target lesions were significant predictors of LNI. At multivariable model, DRE (OR 0.56; C.I.: 0.30-1.05) and SVI (OR: 0.42; C.I.: 0.19-0.93) were the most significant variables, followed by PSA (OR: 0.30; C.I.: 0.21-0.73) and worst GS at I (OR: 0.37; C.I.: 0.17-0.82) and II target lesion (OR: 0.33; C.I.: 0.14-0.76). The AUC was 0.74 [0.67-0.81] 95% CI. This predictive model was subsequently transformed into a visual nomogram, as shown in Figure 1. The cut-off to discriminate LNI risk was set with a Youden index of 60 points, corresponding to a LIN risk of 7%.

CONCLUSIONS:

The results of our study demonstrate that ePLND can be avoided in patients with positive TB only, being the risk of LNI below 7%, in order to spare approximately 59.1% of ePLNDs at the cost of missing only 4.7% positive LNs.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.