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. 2021 May 27;13(11):2627.
doi: 10.3390/cancers13112627.

International Multi-Site Initiative to Develop an MRI-Inclusive Nomogram for Side-Specific Prediction of Extraprostatic Extension of Prostate Cancer

Andreas G Wibmer  1 , Michael W Kattan  2 , Francesco Alessandrino  3 , Alexander D J Baur  4 , Lars Boesen  5 , Felipe Boschini Franco  3 , David Bonekamp  6 , Riccardo Campa  7 , Hannes Cash  4   8 , Violeta Catalá  9   10 , Sebastien Crouzet  11 , Sounil Dinnoo  12 , James Eastham  13 , Fiona M Fennessy  3 , Kamyar Ghabili  14 , Markus Hohenfellner  15 , Angelique W Levi  16 , Xinge Ji  2 , Vibeke Løgager  5 , Daniel J Margolis  17 , Paul C Moldovan  11 , Valeria Panebianco  7 , Tobias Penzkofer  4   18 , Philippe Puech  12 , Jan Philipp Radtke  6   15 , Olivier Rouvière  11   19 , Heinz-Peter Schlemmer  6 , Preston C Sprenkle  14 , Clare M Tempany  3 , Joan C Vilanova  20 , Jeffrey Weinreb  21 , Hedvig Hricak  1 , Amita Shukla-Dave  1
Affiliations

International Multi-Site Initiative to Develop an MRI-Inclusive Nomogram for Side-Specific Prediction of Extraprostatic Extension of Prostate Cancer

Andreas G Wibmer et al. Cancers (Basel). .

Abstract

Background: To develop an international, multi-site nomogram for side-specific prediction of extraprostatic extension (EPE) of prostate cancer based on clinical, biopsy, and magnetic resonance imaging- (MRI) derived data.

Methods: Ten institutions from the USA and Europe contributed clinical and side-specific biopsy and MRI variables of consecutive patients who underwent prostatectomy. A logistic regression model was used to develop a nomogram for predicting side-specific EPE on prostatectomy specimens. The performance of the statistical model was evaluated by bootstrap resampling and cross validation and compared with the performance of benchmark models that do not incorporate MRI findings.

Results: Data from 840 patients were analyzed; pathologic EPE was found in 320/840 (31.8%). The nomogram model included patient age, prostate-specific antigen density, side-specific biopsy data (i.e., Gleason grade group, percent positive cores, tumor extent), and side-specific MRI features (i.e., presence of a PI-RADSv2 4 or 5 lesion, level of suspicion for EPE, length of capsular contact). The area under the receiver operating characteristic curve of the new, MRI-inclusive model (0.828, 95% confidence limits: 0.805, 0.852) was significantly higher than that of any of the benchmark models (p < 0.001 for all).

Conclusions: In an international, multi-site study, we developed an MRI-inclusive nomogram for the side-specific prediction of EPE of prostate cancer that demonstrated significantly greater accuracy than clinical benchmark models.

Keywords: clinical staging; extraprostatic tumor extension; magnetic resonance imaging; nomogram; prostate cancer.

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Conflict of interest statement

A.G.W., F.A., A.D.J.B., L.B., F.B.F., R.C., H.C., V.C., S.C., S.D., J.E., F.M.F., K.G., M.H., A.W.L., X.J., V.L., P.C.M., V.P., P.P., J.P.R., O.R., P.C.S., J.C.V., J.W., A.S.-D.: no conflict of interest; M.W.K.: consultant for Stratify Genomics; D.B.: Bayer Vital, Bayer GmbH, Bayer Healthcare: reception of honorary membership and travel expenses due to lectures held; D.J.M.: institutional in-kind grant from Siemens Healthineers, ad-hoc consulting for Promaxo; T.P.: supported by Berlin Institute of Health (Clinician Scientist Grant, Platform Grant) and reports research agreements (no personal payments, outside of submitted work) with AGO, Aprea AB, ARCAGY-GINECO, Astellas Pharma Global Inc. (APGD), Astra Zeneca, Clovis Oncology, Inc., Dohme Corp, Holaira, Incyte Corporation, Karyopharm, Lion Biotechnologies, Inc., MedImmune, Merck Sharp, Millennium Pharmaceuticals, Inc., Morphotec Inc., NovoCure Ltd., PharmaMar S.A. and PharmaMar USA, Inc., Roche, Siemens Healthineers, and TESARO Inc; H.-P.S.: Bayer Vital, Bayer GmbH, Bayer Healthcare and Siemens Healthineers: reception of honorary membership and travel expenses due to lectures held; C.M.T.: NIH support, Medical advisor: Profound Medical and Promaxo, Clinical Trial support: Insightec; H.H.: Hricak serves on the Board of Directors of Ion Beam Applications (IBA) and receives annual compensation for her service. She also serves, without compensation, on the External Advisory Board, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University; the International Advisory Board, University of Vienna; and the Scientific Committee and Board of Trustees, DKFZ (German Cancer Research Center). Her work on this manuscript was supported by the NIH/NCI P30 Cancer Center Support Grant (CCSG) (P30 CA008748) to Memorial Sloan Kettering Cancer Center. The NIH/NCI had no role in the study, the preparation of the manuscript, or the decision to submit it for publication.

Figures

Figure 1
Figure 1
MRI-inclusive nomogram for the side-specific prediction of extraprostatic extension of prostate cancer.
Figure 2
Figure 2
Decision curve analyses for the proposed MRI-inclusive nomogram and the benchmark models. The y-axis depicts the benefit of each nomogram to identify EPE correctly, and the x-axis refers to how clinicians appraise different outcomes in a given clinical context. A detailed guide for the interpretation of decision curves can be found in [30].
Figure 3
Figure 3
Calibration plot for the proposed MRI-inclusive nomogram and the benchmark models illustrating the actual frequency of EPE on the y-axis and the predicted probability on the x-axis (a more in-depth explanation can be found in [31]).
See this image and copyright information in PMC

References

    1. Woo S., Suh C.H., Eastham J.A., Zelefsky M.J., Morris M.J., Abida W., Scher H.I., Sidlow R., Becker A.S., Wibmer A.G., et al. Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur. Urol. Oncol. 2019;2:605–616. doi: 10.1016/j.euo.2019.05.004. - DOI - PMC - PubMed
    1. Pagniez M.A., Kasivisvanathan V., Puech P., Drumez E., Villers A., Olivier J. Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. J. Urol. 2020;204:24–32. doi: 10.1097/JU.0000000000000757. - DOI - PubMed
    1. Falagario U.G., Ratnani P., Lantz A., Jambor I., Dovey Z., Verma A., Treacy P.-J., Sobotka S., Martini A., Bashorun H., et al. Staging Accuracy of Multiparametric Magnetic Resonance Imaging in Caucasian and African American Men Undergoing Radical Prostatectomy. J. Urol. 2020;204:82–90. doi: 10.1097/JU.0000000000000774. - DOI - PubMed
    1. De Rooij M., Hamoen E.H., Witjes J.A., Barentsz J.O., Rovers M.M. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur. Urol. 2016;70:233–245. doi: 10.1016/j.eururo.2015.07.029. - DOI - PubMed
    1. Brown J.A., Rodin D.M., Harisinghani M., Dahl D.M. Impact of preoperative endorectal MRI stage classification on neurovascular bundle sparing aggressiveness and the radical prostatectomy positive margin rate. Urol. Oncol. Semin. Orig. Investig. 2009;27:174–179. doi: 10.1016/j.urolonc.2008.04.009. - DOI - PubMed