A Nomogram for Predicting Prostate Cancer with Lymph Node Involvement in Robot-Assisted Radical Prostatectomy Era: A Retrospective Multicenter Cohort Study in Japan (The MSUG94 Group)
Makoto Kawase,
Shin Ebara,
Tomoyuki Tatenuma,
Takeshi Sasaki,
Yoshinori Ikehata,
Akinori Nakayama,
Masahiro Toide,
Tatsuaki Yoneda,
Kazushige Sakaguchi,
Takuma Ishihara,
Jun Teishima,
Kazuhide Makiyama,
Takahiro Inoue,
Hiroshi Kitamura,
Kazutaka Saito,
Fumitaka Koga,
Shinji Urakami,
Takuya Koie
Affiliations
Makoto Kawase
Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
Shin Ebara
Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 7308518, Japan
Tomoyuki Tatenuma
Department of Urology, Yokohama City University, Yokohama 2360004, Japan
Takeshi Sasaki
Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu 5148507, Japan
Yoshinori Ikehata
Department of Urology, University of Toyama, Toyama 9300194, Japan
Akinori Nakayama
Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya 3438555, Japan
Masahiro Toide
Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 1138677, Japan
Tatsuaki Yoneda
Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu 4308558, Japan
Kazushige Sakaguchi
Department of Urology, Toranomon Hospital, Tokyo 1058470, Japan
Takuma Ishihara
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu 5011194, Japan
Jun Teishima
Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, Kobe 6530013, Japan
Kazuhide Makiyama
Department of Urology, Yokohama City University, Yokohama 2360004, Japan
Takahiro Inoue
Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu 5148507, Japan
Hiroshi Kitamura
Department of Urology, University of Toyama, Toyama 9300194, Japan
Kazutaka Saito
Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya 3438555, Japan
Fumitaka Koga
Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 1138677, Japan
Shinji Urakami
Department of Urology, Toranomon Hospital, Tokyo 1058470, Japan
Takuya Koie
Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
Background: To create a nomogram for predicting prostate cancer (PCa) with lymph node involvement (LNI) in the robot-assisted radical prostatectomy (RARP) era. Methods: A retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP at nine institutions in Japan between September 2012 and August 2021. A multivariable logistic regression model was used to identify factors strongly associated with LNI. The Bootstrap-area under the curve (AUC) was calculated to assess the internal validity of the prediction model. Results: A total of 1855 patients were enrolled in this study. Overall, 93 patients (5.0%) had LNI. On multivariable analyses, initial prostate-specific antigen, number of cancer-positive and-negative biopsy cores, biopsy Gleason grade, and clinical T stage were independent predictors of PCa with LNI. The nomogram predicting PCa with LNI has been demonstrated (AUC 84%). Using a nomogram cut-off of 6%, 492 of 1855 patients (26.5%) would avoid unnecessary pelvic lymph node dissection, and PCa with LNI would be missed in two patients (0.1%). The sensitivity, specificity, and negative predictive values associated with a cutoff of 6% were 74%, 80%, and 99.6%, respectively. Conclusions: We developed a clinically applicable nomogram for predicting the probability of patients with PCa with LNI.
