External evaluation of the Briganti nomogram to predict lymph node metastases in intermediate-risk prostate cancer patients

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

The Briganti nomogram in our retrospective cohort showed low accuracy for the prediction of lymph node involvement in an intermediate-risk prostate cancer population.

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Acknowledgments

Gaelle Fiard receives funding from and wishes to thank the Fondation de France and the European Urology Scholarship Program.

Funding

Gaelle Fiard receives funding from and wishes to thank the Fondation de France and the European Urology Scholarship Program.

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Affiliations

Authors

Contributions

NP: Protocol/project development, Data collection or management, Manuscript writing/editing, AS: Data analysis, CH: Data analysis, CV: Manuscript writing/editing, MB: Manuscript writing/editing, JJR: Manuscript writing/editing, JLD: Protocol/project development, JAL: Manuscript writing/editing, GF: Protocol/project development, Manuscript writing/editing.

Corresponding author

Correspondence to Gaelle Fiard.

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De-identified data will be made readily available to reviewers upon request.

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The authors declare that they have no conflict of interest.

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Statistical software code will be made readily available to reviewers upon request.

Ethics approval

This retrospective study conducted from medical charts used data obtained during routine care. Data protection declaration was performed with the CNIL under number 2216943v0.

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Cite this article

Peilleron, N., Seigneurin, A., Herault, C. et al. External evaluation of the Briganti nomogram to predict lymph node metastases in intermediate-risk prostate cancer patients. World J Urol (2020). https://doi.org/10.1007/s00345-020-03322-9

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Keywords

  • Prostate cancer
  • Lymph node dissection
  • Nomogram
  • Radical prostatectomy