Indication to pelvic lymph nodes dissection for prostate cancer: The role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5%

Francesco Porpiglia, Matteo Manfredi, Fabrizio Mele, Riccardo Bertolo, Enrico Bollito, Dario Gned, Agostino De Pascale, Filippo Russo, Roberto Passera, Cristian Fiori, Stefano De Luca

Research output: Contribution to journalArticle

Abstract

Background: The Briganti updated nomogram (BN) is the most popular predictive model aiming to predict the presence of lymph node invasion (LNI) in patients with prostate cancer (PCa), but it lacks information obtained by preoperative imaging. The primary aim of the study was to evaluate the role of multiparametric prostate magnetic resonance imaging (mp-MRI) in the indication to perform pelvic lymph nodes dissection (PLND) or not in patients with risk of LNI according to BN below 5%. Methods: Since March 2012 and September 2016, 310 patients who underwent a preoperative mp-MRI for staging purpose and subsequent robot-assisted extended PLND (RAEPLND) were retrospectively evaluated. Mp-MRIs were prospectively analyzed by two experienced radiologists. The imaging parameters analyzed were the presence of extracapsular extension (ECE), seminal vesicles invasion (SVI) and predominant Gleason pattern 4 (pG4). All patients underwent RAEPLND by two experienced surgeons with a standardized technique. A dedicated uropathologist performed all pathological analysis. Univariate analysis and multivariate logistic regression analysis were used in order to identify the predictors of LNI in patients with PCa. Results: In the overall population, 57 (18.4%) patients had histologically proven pN1 disease. 48/250 patients (19.2%) with a risk of LNI ≥5% as calculated by the BN were staged pN1 at final histopathological analysis. 9/60 patients (15.0%) with a risk of LNI <5% as calculated by BN, who underwent RAEPLND anyway according to the findings at mp-MRI, were staged pN1 at final histopathological analysis. At multivariate logistic regression analysis, all the three mp-MRI parameters were significant independent predictors of LNI after RAEPLND. Conclusions: The role of mp-MRI seemed to be crucial in patients with a risk of LNI <5% as calculated by the BN. The presence of ECE, SVI, or pG4 at mp-MRI was found to be an independent predictor of LNI by itself.

Original languageEnglish
Pages (from-to)85-91
Number of pages7
JournalProstate Cancer and Prostatic Diseases
Volume21
Issue number1
DOIs
Publication statusPublished - Apr 1 2018

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Nomograms
Lymph Node Excision
Prostatic Neoplasms
Lymph Nodes
Magnetic Resonance Imaging
Prostate
Seminal Vesicles
Logistic Models
Regression Analysis
Multivariate Analysis

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Cancer Research

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Indication to pelvic lymph nodes dissection for prostate cancer : The role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5%. / Porpiglia, Francesco; Manfredi, Matteo; Mele, Fabrizio; Bertolo, Riccardo; Bollito, Enrico; Gned, Dario; De Pascale, Agostino; Russo, Filippo; Passera, Roberto; Fiori, Cristian; De Luca, Stefano.

In: Prostate Cancer and Prostatic Diseases, Vol. 21, No. 1, 01.04.2018, p. 85-91.

Research output: Contribution to journalArticle

Porpiglia, Francesco ; Manfredi, Matteo ; Mele, Fabrizio ; Bertolo, Riccardo ; Bollito, Enrico ; Gned, Dario ; De Pascale, Agostino ; Russo, Filippo ; Passera, Roberto ; Fiori, Cristian ; De Luca, Stefano. / Indication to pelvic lymph nodes dissection for prostate cancer : The role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5%. In: Prostate Cancer and Prostatic Diseases. 2018 ; Vol. 21, No. 1. pp. 85-91.
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abstract = "Background: The Briganti updated nomogram (BN) is the most popular predictive model aiming to predict the presence of lymph node invasion (LNI) in patients with prostate cancer (PCa), but it lacks information obtained by preoperative imaging. The primary aim of the study was to evaluate the role of multiparametric prostate magnetic resonance imaging (mp-MRI) in the indication to perform pelvic lymph nodes dissection (PLND) or not in patients with risk of LNI according to BN below 5{\%}. Methods: Since March 2012 and September 2016, 310 patients who underwent a preoperative mp-MRI for staging purpose and subsequent robot-assisted extended PLND (RAEPLND) were retrospectively evaluated. Mp-MRIs were prospectively analyzed by two experienced radiologists. The imaging parameters analyzed were the presence of extracapsular extension (ECE), seminal vesicles invasion (SVI) and predominant Gleason pattern 4 (pG4). All patients underwent RAEPLND by two experienced surgeons with a standardized technique. A dedicated uropathologist performed all pathological analysis. Univariate analysis and multivariate logistic regression analysis were used in order to identify the predictors of LNI in patients with PCa. Results: In the overall population, 57 (18.4{\%}) patients had histologically proven pN1 disease. 48/250 patients (19.2{\%}) with a risk of LNI ≥5{\%} as calculated by the BN were staged pN1 at final histopathological analysis. 9/60 patients (15.0{\%}) with a risk of LNI <5{\%} as calculated by BN, who underwent RAEPLND anyway according to the findings at mp-MRI, were staged pN1 at final histopathological analysis. At multivariate logistic regression analysis, all the three mp-MRI parameters were significant independent predictors of LNI after RAEPLND. Conclusions: The role of mp-MRI seemed to be crucial in patients with a risk of LNI <5{\%} as calculated by the BN. The presence of ECE, SVI, or pG4 at mp-MRI was found to be an independent predictor of LNI by itself.",
author = "Francesco Porpiglia and Matteo Manfredi and Fabrizio Mele and Riccardo Bertolo and Enrico Bollito and Dario Gned and {De Pascale}, Agostino and Filippo Russo and Roberto Passera and Cristian Fiori and {De Luca}, Stefano",
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T1 - Indication to pelvic lymph nodes dissection for prostate cancer

T2 - The role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5%

AU - Porpiglia, Francesco

AU - Manfredi, Matteo

AU - Mele, Fabrizio

AU - Bertolo, Riccardo

AU - Bollito, Enrico

AU - Gned, Dario

AU - De Pascale, Agostino

AU - Russo, Filippo

AU - Passera, Roberto

AU - Fiori, Cristian

AU - De Luca, Stefano

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N2 - Background: The Briganti updated nomogram (BN) is the most popular predictive model aiming to predict the presence of lymph node invasion (LNI) in patients with prostate cancer (PCa), but it lacks information obtained by preoperative imaging. The primary aim of the study was to evaluate the role of multiparametric prostate magnetic resonance imaging (mp-MRI) in the indication to perform pelvic lymph nodes dissection (PLND) or not in patients with risk of LNI according to BN below 5%. Methods: Since March 2012 and September 2016, 310 patients who underwent a preoperative mp-MRI for staging purpose and subsequent robot-assisted extended PLND (RAEPLND) were retrospectively evaluated. Mp-MRIs were prospectively analyzed by two experienced radiologists. The imaging parameters analyzed were the presence of extracapsular extension (ECE), seminal vesicles invasion (SVI) and predominant Gleason pattern 4 (pG4). All patients underwent RAEPLND by two experienced surgeons with a standardized technique. A dedicated uropathologist performed all pathological analysis. Univariate analysis and multivariate logistic regression analysis were used in order to identify the predictors of LNI in patients with PCa. Results: In the overall population, 57 (18.4%) patients had histologically proven pN1 disease. 48/250 patients (19.2%) with a risk of LNI ≥5% as calculated by the BN were staged pN1 at final histopathological analysis. 9/60 patients (15.0%) with a risk of LNI <5% as calculated by BN, who underwent RAEPLND anyway according to the findings at mp-MRI, were staged pN1 at final histopathological analysis. At multivariate logistic regression analysis, all the three mp-MRI parameters were significant independent predictors of LNI after RAEPLND. Conclusions: The role of mp-MRI seemed to be crucial in patients with a risk of LNI <5% as calculated by the BN. The presence of ECE, SVI, or pG4 at mp-MRI was found to be an independent predictor of LNI by itself.

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