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Independent external validation of nomogram to predict extracapsular extension in patients with prostate cancer

  • Oncology
  • Published:
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Abstract

Introduction

The objective of this study was to perform an independent external validation of the Giganti-Coppola nomogram (GCN), which uses clinical and radiological parameters to predict prostate extracapsular extension (ECE) on the final pathology of patients undergoing radical prostatectomy (RP).

Material and methods

Seventy-two patients diagnosed with prostate cancer (PCa), who were RP candidates from two institutions, were prospectively included. All patients underwent preoperative multi-parametric magnetic resonance imaging (mpMRI) at 1.5 T, without the use of an endorectal coil, with multiplanar images in T1WI, T2WI, DWI, and DCE. The AUC and a calibration graph were used to validate the nomogram, using the regression coefficients of the Giganti-Coppola study.

Results

The original nomogram had an AUC of 0.90 (p = 0.001), with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 5.1%, 47.1%, 100%, and 48%, respectively. The calibration graph showed an overestimation of the nomogram for ECE.

Conclusion

The GCN has an adequate ability in predicting ECE; however, in our sample, it showed limited accuracy and overestimated likelihood of ECE in the final pathology of patients with PCa submitted to RP.

Key Points

• Knowledge of preoperative local staging of prostate cancer is essential for surgical treatment. Extracapsular extension increases the chance of positive surgical margins.

• Imaging modalities such as mpMRI alone does not have suitable accuracy in local staging.

• Giganti-Coppola’s nomogram achieved an adequate ability in predicting ECE.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the ROC curve

DCE:

Dynamic contrast-enhanced

DRE:

Digital rectal examination

DWI:

Diffusion-weighted imaging

ECE:

Extraprostatic extension

ERC:

Endorectal coil

GCN:

Giganti-Coppola nomogram

ICC:

Intraclass correlation coefficient

mpMRI:

Multi-parametric magnetic resonance imaging

NVBs:

Neuro vascular bundles

OR:

Odds ratio

PCa:

Prostate cancer

PI-RADS:

Prostate Imaging Reporting and Data

PPV:

Positive predictive value

PSA:

Prostate specific antigen

RP:

Radical prostatectomy

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

TRUS:

Transrectal ultrasound

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Acknowledgments

This work was undertaken at Barreto’s Cancer Hospital, Barretos Brazil, and medical school of the hospital of the clinics of USP from Ribeirao Preto, Brazil.

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Authors and Affiliations

  1. Department of Urology, Barretos Cancer Hospital, Barretos, R. Antenor Duarte Vilela, 1331, Barretos, São Paulo, 14784-400, Brazil

    Joao Ricardo Alves, Cinthia Alcantara-Quispe & Eliney F. Faria

  2. Department of Urology, Base Hospital of Federal District, Brasilia, Brazil

    Joao Ricardo Alves

  3. Department of Radiology, University of Sao Paulo Hospital of Medical School, Ribeirão Preto, Brazil

    Valdair F. Muglia

  4. Department of Radiology, Barretos Cancer Hospital, Barretos, Brazil

    Fabiano R. Lucchesi & Raisa A. O. G. Faria

  5. Research and Education Institute, Barretos Cancer Hospital, Barretos, Brazil

    Vinicius L. Vazquez

  6. Department of Urology, University of Sao Paulo Hospital of Medical School, Ribeirão Preto, Brazil

    Rodolfo B. Reis

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  1. Joao Ricardo Alves
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Correspondence to Joao Ricardo Alves.

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Guarantor

The scientific guarantor of this publication is Barretos Cancer Hospital and University of Sao Paulo.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Marco A. Oliveira kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained (1189/2016).

Methodology

• Prospective

• Diagnostic or prognostic study

• Multicenter study

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Alves, J.R., Muglia, V.F., Lucchesi, F.R. et al. Independent external validation of nomogram to predict extracapsular extension in patients with prostate cancer. Eur Radiol 30, 5004–5010 (2020). https://doi.org/10.1007/s00330-020-06839-0

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