Yonsei nomogram to predict lymph node invasion in A sian men with prostate cancer during robotic era

Objective To develop a novel nomogram to predict lymph node invasion ( LNI ) in A sian men undergoing radical prostatectomy ( RP ) and pelvic LN dissection ( PLND ) for localised prostate cancer.Patients and Methods The patient cohort included 541 patients who underwent robot‐assisted RP and PLND by a single surgeon between J anuary 2008 and D ecember 2011. Patients with dissection of <10 LNs , prostate‐specific antigen ( PSA ) levels of >50 ng/mL, incomplete biopsy data, and treatment with neoadjuvant therapy were excluded.Results The median (interquartile range) number of LNs removed was 17 (14–22) and 45 patients (8.3%) had LN metastases. On multivariate logistic regression analysis, PSA level, clinical stage and G leason score were independent predictors of LNI . The bootstrap corrected area under curve of the model incorporating PSA level, clinical stage, and biopsy G leason score was 0.883. With a cutoff value of 4%, PLND could be omitted in 326 patients (60.2%), missing only two patients (4.4%) with LNI . The sensitivity, specificity, positive predictive value and negative predictive value were 95.6%, 65.3%, 20.0% and 99.4%, respectively.Conclusions We report a nomogram to predict LNI in A sian men with prostate cancer. The model demonstrated high accuracy and could be used for counselling patients and the selection of candidates for PLND .