Open AccessDevelopment and validation of a nomogram including lymphocyte-to-monocyte ratio for initial prostate biopsy: a double-center retrospective study
Author(s) -
Zhonghan Zhou,
Feng Liu,
Wenjie Wang,
Xue Li,
Lijun Sun,
Yushan Zhu,
Dingwei Ye,
Guiming Zhang
Publication year - 2021
Publication title -
asian journal of andrology/asian journal of andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 74
eISSN - 1745-7262
pISSN - 1008-682X
DOI - 10.4103/aja.aja_19_20
Subject(s) - nomogram , medicine , confidence interval , prostate cancer , logistic regression , urology , prostate biopsy , prostate specific antigen , multivariate analysis , area under the curve , oncology , cancer
Here, we developed a prostate cancer (PCa) risk nomogram including lymphocyte-to-monocyte ratio (LMR) for initial prostate biopsy, and internal and external validation were further conducted. A prediction model was developed on a training set. Significant risk factors with P < 0.10 in multivariate logistic regression models were used to generate a nomogram. Discrimination, calibration, and clinical usefulness of the model were assessed using C-index, calibration plot, and decision curve analysis (DCA). The nomogram was re-examined with the internal and external validation set. A nomogram predicting PCa risk in patients with prostate-specific antigen (PSA) 4-10 ng ml -1 was also developed. The model displayed good discrimination with C-index of 0.830 (95% confidence interval [CI]: 0.812-0.852). High C-index of 0.864 (95% CI: 0.840-0.888) and 0.871 (95% CI: 0.861-0.881) was still reached in the internal and external validation sets, respectively. The nomogram exhibited better performance compared to the nomogram with PSA only (C-index: 0.763, 95% CI: 0.746-0.780, P < 0.001) and the nomogram with LMR excluded (C-index: 0.824, 95% CI: 0.804-0.844, P < 0.010). The calibration curve demonstrated good agreement in the internal and external validation sets. DCA showed that the nomogram was useful at the threshold probability of >4% and <99%. The nomogram predicting PCa risk in patients with PSA 4-10 ng ml -1 also displayed good calibration and discrimination performance (C-index: 0.734, 95% CI: 0.708-0.760). This nomogram incorporating age, PSA, digital rectal examination, abnormal imaging signals, PSA density, and LMR could be used to facilitate individual PCa risk prediction in initial prostate biopsy.