European journal of nuclear medicine and molecular imaging · 2025
External validation of nomograms including PSMA PET information for the prediction of lymph node involvement of prostate cancer.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Van Bergen Tessa D, Braat Arthur J A T, Hermsen Rick, Heetman Joris G, Wever Lieke, Lavalaye Jules, Vinken Maarten, Bahler Clinton D, Tann Mark, Kesch Claudia, Telli Tugce, Chiu Peter Ka-Fung, Wu Kwan Kit, Zattoni Fabio, Evangelista Laura, Ceci Francesco, Miszczyk Marcin, Rajwa Pawel, Barletta Francesco, Gandaglia Giorgio, Van Basten Jean-Paul A, Scheltema Matthijs J, Van Melick Harm H E, Van den Bergh Roderick C N, Van den Berg Cornelis A T, Marra Giancarlo, Soeterik Timo F W, EAU-YAU Prostate Cancer Working Party
Аннотация
BACKGROUND: Novel nomograms predicting lymph node involvement (LNI) of prostate cancer (PCa) including PSMA PET information have been developed. However, their predictive accuracy in external populations is still unclear.
PURPOSE: To externally validate four LNI nomograms including PSMA PET parameters (three Muehlematter models and the Amsterdam-Brisbane-Sydney model) as well as the Briganti 2012 and MSKCC nomograms.
METHODS: Patients with histologically confirmed PCa undergoing preoperative MRI and PSMA PET/CT before radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) were included. Model discrimination (AUC), calibration and net benefit using decision curve analysis were determined for each nomogram.
RESULTS: A total of 437 patients were included, comprising 0.7% with low-risk disease, 39.8% with intermediate-risk disease, and 59.5% with high-risk disease. Among them, 86 out of 437 (19.7%) had pN1 disease. The sensitivity and specificity of PSMA PET/CT for the detection of LNI were 47.7% (95% CI: 36.8-58.7) and 95.4% (95% CI: 92.7-97.4), respectively. Among predictive models, the Amsterdam-Brisbane-Sydney model achieved the highest discrimination (AUC: 0.81, 95% CI: 0.76-0.86), followed by Muehlematter Model 1 (AUC: 0.79, 95% CI: 0.74-0.85), both with good calibration but slight systematic overestimation of risks across all thresholds. The MSKCC and Briganti 2012 models had AUCs of 0.68 (95% CI: 0.61-0.74) and 0.67 (95% CI: 0.61-0.73), respectively, and both had moderate calibration. Decision curve analysis indicated that the Amsterdam-Brisbane-Sydney model provided superior net benefit across thresholds of 5-20%, followed by the Muehlematter Model 1 nomogram showing benefit in the 14-20% range. Using thresholds of 8% for the Amsterdam-Brisbane-Sydney nomogram and 15% for Muehlematter Model 1, ePLND could be spared in 15% and 16% of patients, respectively, without missing any LNI cases.
CONCLUSION: External validation of the Muehlematter Model 1 and Amsterdam-Brisbane-Sydney nomograms for predicting LNI confirmed their strong model discrimination, moderate calibration, and good clinical utility, supporting their reliability as tools to guide clinical decision-making.
PURPOSE: To externally validate four LNI nomograms including PSMA PET parameters (three Muehlematter models and the Amsterdam-Brisbane-Sydney model) as well as the Briganti 2012 and MSKCC nomograms.
METHODS: Patients with histologically confirmed PCa undergoing preoperative MRI and PSMA PET/CT before radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) were included. Model discrimination (AUC), calibration and net benefit using decision curve analysis were determined for each nomogram.
RESULTS: A total of 437 patients were included, comprising 0.7% with low-risk disease, 39.8% with intermediate-risk disease, and 59.5% with high-risk disease. Among them, 86 out of 437 (19.7%) had pN1 disease. The sensitivity and specificity of PSMA PET/CT for the detection of LNI were 47.7% (95% CI: 36.8-58.7) and 95.4% (95% CI: 92.7-97.4), respectively. Among predictive models, the Amsterdam-Brisbane-Sydney model achieved the highest discrimination (AUC: 0.81, 95% CI: 0.76-0.86), followed by Muehlematter Model 1 (AUC: 0.79, 95% CI: 0.74-0.85), both with good calibration but slight systematic overestimation of risks across all thresholds. The MSKCC and Briganti 2012 models had AUCs of 0.68 (95% CI: 0.61-0.74) and 0.67 (95% CI: 0.61-0.73), respectively, and both had moderate calibration. Decision curve analysis indicated that the Amsterdam-Brisbane-Sydney model provided superior net benefit across thresholds of 5-20%, followed by the Muehlematter Model 1 nomogram showing benefit in the 14-20% range. Using thresholds of 8% for the Amsterdam-Brisbane-Sydney nomogram and 15% for Muehlematter Model 1, ePLND could be spared in 15% and 16% of patients, respectively, without missing any LNI cases.
CONCLUSION: External validation of the Muehlematter Model 1 and Amsterdam-Brisbane-Sydney nomograms for predicting LNI confirmed their strong model discrimination, moderate calibration, and good clinical utility, supporting their reliability as tools to guide clinical decision-making.