Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy
•Nerve-sparing is not recommended in patients with high risk of extraprostatic disease.•Microultrsound has shown a promising role in prostate cancer staging.•We developed a microultrasound-based nomogram predicting extra-prostatic extension.•The model showed an accuracy of 84.1% in the prediction of...
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| Veröffentlicht in: | Urologic oncology 2024-05, Vol.42 (5), p.159.e9-159.e16 |
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| creator | Frego, Nicola Contieri, Roberto Fasulo, Vittorio Maffei, Davide Avolio, Pier Paolo Arena, Paola Beatrici, Edoardo Sordelli, Federica De Carne, Fabio Lazzeri, Massimo Saita, Alberto Hurle, Rodolfo Buffi, Nicolò Maria Casale, Paolo Lughezzani, Giovanni |
| description | •Nerve-sparing is not recommended in patients with high risk of extraprostatic disease.•Microultrsound has shown a promising role in prostate cancer staging.•We developed a microultrasound-based nomogram predicting extra-prostatic extension.•The model showed an accuracy of 84.1% in the prediction of extraprostatic disease.•Microultrasound-based nomogram could aid urologists whether to perform nerve sparing.
To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing.
All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).
Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them.
We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results. |
| doi_str_mv | 10.1016/j.urolonc.2024.01.033 |
| format | Article |
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To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing.
All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).
Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them.
We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results.</description><identifier>ISSN: 1078-1439</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2024.01.033</identifier><identifier>PMID: 38423852</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Extra-prostatic extension ; Humans ; Male ; Microultrasound ; Nomogram ; Nomograms ; Positive surgical margins ; Prostate - diagnostic imaging ; Prostate - pathology ; Prostate - surgery ; Prostatectomy - methods ; Prostatic Neoplasms - diagnostic imaging ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Retrospective Studies ; Robot-assisted radical prostatectomy ; Robotics</subject><ispartof>Urologic oncology, 2024-05, Vol.42 (5), p.159.e9-159.e16</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c313t-bf2c6876fc4688ef00bc94da6429c739b24d545dd886a41a1bdd3c774f22e88b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urolonc.2024.01.033$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38423852$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frego, Nicola</creatorcontrib><creatorcontrib>Contieri, Roberto</creatorcontrib><creatorcontrib>Fasulo, Vittorio</creatorcontrib><creatorcontrib>Maffei, Davide</creatorcontrib><creatorcontrib>Avolio, Pier Paolo</creatorcontrib><creatorcontrib>Arena, Paola</creatorcontrib><creatorcontrib>Beatrici, Edoardo</creatorcontrib><creatorcontrib>Sordelli, Federica</creatorcontrib><creatorcontrib>De Carne, Fabio</creatorcontrib><creatorcontrib>Lazzeri, Massimo</creatorcontrib><creatorcontrib>Saita, Alberto</creatorcontrib><creatorcontrib>Hurle, Rodolfo</creatorcontrib><creatorcontrib>Buffi, Nicolò Maria</creatorcontrib><creatorcontrib>Casale, Paolo</creatorcontrib><creatorcontrib>Lughezzani, Giovanni</creatorcontrib><title>Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>•Nerve-sparing is not recommended in patients with high risk of extraprostatic disease.•Microultrsound has shown a promising role in prostate cancer staging.•We developed a microultrasound-based nomogram predicting extra-prostatic extension.•The model showed an accuracy of 84.1% in the prediction of extraprostatic disease.•Microultrasound-based nomogram could aid urologists whether to perform nerve sparing.
To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing.
All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).
Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them.
We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results.</description><subject>Extra-prostatic extension</subject><subject>Humans</subject><subject>Male</subject><subject>Microultrasound</subject><subject>Nomogram</subject><subject>Nomograms</subject><subject>Positive surgical margins</subject><subject>Prostate - diagnostic imaging</subject><subject>Prostate - pathology</subject><subject>Prostate - surgery</subject><subject>Prostatectomy - methods</subject><subject>Prostatic Neoplasms - diagnostic imaging</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Robot-assisted radical prostatectomy</subject><subject>Robotics</subject><issn>1078-1439</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtv1DAUhS1ERZ8_AeQlm6R-JXFWFSp9IFXqpqwtx74ZPErsYDst_UH8Tzyaabes_NB3z9E9B6HPlNSU0PZyW68xTMGbmhEmakJrwvkHdEJlxysm-vZjuZNOVlTw_hidprQlhApJ6Sd0zKVgXDbsBP39Ds8whWUGn3EYscazMzGsU446hdXbatAJLPZhDpuoZ5wDXiJYZzKGPwWqlhhS1tmZ3Rt8csFj5_FSvopmwi8u_8IHCLDR3kDERRjiJji_wTEMIVc6JZdyMYq6aOvpfcLkML-eo6NRTwkuDucZ-nl783R9Xz083v24_vZQGU55roaRmVZ27WhEKyWMhAymF1a3gvWm4_3AhG1EY62UrRZU08FabrpOjIyBlAM_Q1_3usX99wopq9klA9OkPYQ1KdZzwbqG0aagzR4taaUUYVRLdLOOr4oStWtIbdWhIbVrSBGqSkNl7svBYh1msO9Tb5UU4GoPQFn02UFUyZQkTck8ljSUDe4_Fv8APNmrJA</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Frego, Nicola</creator><creator>Contieri, Roberto</creator><creator>Fasulo, Vittorio</creator><creator>Maffei, Davide</creator><creator>Avolio, Pier Paolo</creator><creator>Arena, Paola</creator><creator>Beatrici, Edoardo</creator><creator>Sordelli, Federica</creator><creator>De Carne, Fabio</creator><creator>Lazzeri, Massimo</creator><creator>Saita, Alberto</creator><creator>Hurle, Rodolfo</creator><creator>Buffi, Nicolò Maria</creator><creator>Casale, Paolo</creator><creator>Lughezzani, Giovanni</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202405</creationdate><title>Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy</title><author>Frego, Nicola ; Contieri, Roberto ; Fasulo, Vittorio ; Maffei, Davide ; Avolio, Pier Paolo ; Arena, Paola ; Beatrici, Edoardo ; Sordelli, Federica ; De Carne, Fabio ; Lazzeri, Massimo ; Saita, Alberto ; Hurle, Rodolfo ; Buffi, Nicolò Maria ; Casale, Paolo ; Lughezzani, Giovanni</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-bf2c6876fc4688ef00bc94da6429c739b24d545dd886a41a1bdd3c774f22e88b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Extra-prostatic extension</topic><topic>Humans</topic><topic>Male</topic><topic>Microultrasound</topic><topic>Nomogram</topic><topic>Nomograms</topic><topic>Positive surgical margins</topic><topic>Prostate - diagnostic imaging</topic><topic>Prostate - pathology</topic><topic>Prostate - surgery</topic><topic>Prostatectomy - methods</topic><topic>Prostatic Neoplasms - diagnostic imaging</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Robot-assisted radical prostatectomy</topic><topic>Robotics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frego, Nicola</creatorcontrib><creatorcontrib>Contieri, Roberto</creatorcontrib><creatorcontrib>Fasulo, Vittorio</creatorcontrib><creatorcontrib>Maffei, Davide</creatorcontrib><creatorcontrib>Avolio, Pier Paolo</creatorcontrib><creatorcontrib>Arena, Paola</creatorcontrib><creatorcontrib>Beatrici, Edoardo</creatorcontrib><creatorcontrib>Sordelli, Federica</creatorcontrib><creatorcontrib>De Carne, Fabio</creatorcontrib><creatorcontrib>Lazzeri, Massimo</creatorcontrib><creatorcontrib>Saita, Alberto</creatorcontrib><creatorcontrib>Hurle, Rodolfo</creatorcontrib><creatorcontrib>Buffi, Nicolò Maria</creatorcontrib><creatorcontrib>Casale, Paolo</creatorcontrib><creatorcontrib>Lughezzani, Giovanni</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frego, Nicola</au><au>Contieri, Roberto</au><au>Fasulo, Vittorio</au><au>Maffei, Davide</au><au>Avolio, Pier Paolo</au><au>Arena, Paola</au><au>Beatrici, Edoardo</au><au>Sordelli, Federica</au><au>De Carne, Fabio</au><au>Lazzeri, Massimo</au><au>Saita, Alberto</au><au>Hurle, Rodolfo</au><au>Buffi, Nicolò Maria</au><au>Casale, Paolo</au><au>Lughezzani, Giovanni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2024-05</date><risdate>2024</risdate><volume>42</volume><issue>5</issue><spage>159.e9</spage><epage>159.e16</epage><pages>159.e9-159.e16</pages><issn>1078-1439</issn><eissn>1873-2496</eissn><abstract>•Nerve-sparing is not recommended in patients with high risk of extraprostatic disease.•Microultrsound has shown a promising role in prostate cancer staging.•We developed a microultrasound-based nomogram predicting extra-prostatic extension.•The model showed an accuracy of 84.1% in the prediction of extraprostatic disease.•Microultrasound-based nomogram could aid urologists whether to perform nerve sparing.
To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing.
All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).
Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them.
We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38423852</pmid><doi>10.1016/j.urolonc.2024.01.033</doi></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1078-1439 |
| ispartof | Urologic oncology, 2024-05, Vol.42 (5), p.159.e9-159.e16 |
| issn | 1078-1439 1873-2496 |
| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Extra-prostatic extension Humans Male Microultrasound Nomogram Nomograms Positive surgical margins Prostate - diagnostic imaging Prostate - pathology Prostate - surgery Prostatectomy - methods Prostatic Neoplasms - diagnostic imaging Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Retrospective Studies Robot-assisted radical prostatectomy Robotics |
| title | Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy |
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