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Clinical Research

Preoperative PI-RADS Version 2 scores helps improve accuracy of clinical nomograms for predicting pelvic lymph node metastasis at radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 23, pages 116–126 (2020)Cite this article

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Abstract

Background

Lymph node invasion (LNI) is a strong adverse prognostic factor in prostate cancer (PCa). The purpose of this study was to evaluate the role of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scores for estimating the risk of LN metastasis. The study also aimed to investigate the additional value of PI-RADSv2 scores when used in combination with clinical nomograms for the prediction of LNI in patients with PCa.

Methods

We retrospectively identified 308 patients who underwent multiparametric magnetic resonance imaging (mpMRI) and RP with pelvic lymph node dissection (PLND). Clinicopathological parameters and PI-RADSv2 scores were assessed. Univariate and multivariate logistic analyses were performed. The area under the receiver operating characteristic curves (AUCs) and decision curve analysis (DCA) were generated for assessing the incremental value of PI-RADSv2 scores combined with the Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms.

Results

Overall, 20 (6.5%) patients had LNI. At univariate analysis, all clinicopathological characteristics and PI-RADSv2 scores were significantly associated to LNI (p < 0.04). However, multivariate analysis revealed that only PI-RADSv2 scores and percentage of positive cores were independently significant (p ≤ 0.006). The PI-RADSv2 score was the most accurate predictor (AUC, 80.2%). The threshold of PI-RADSv2 score was 5, which provided high sensitivity (18/20, 90.0%) and negative predictive value (203/205, 99.0%). When PI-RADSv2 scores were combined with Briganti and MSKCC nomograms, the AUC value increased from 75.1 to 86.3% and from 79.2 to 87.9%, respectively (p ≤ 0.001). The DCA also demonstrated that the two nomograms plus PI-RADSv2 scores improved clinical risk prediction of LNI.

Conclusions

The patients with a PI-RADSv2 score <5 were associated with a very low risk of LNI in PCa. Preoperative PI-RADSv2 scores could help improve the accuracy of clinical nomograms for predicting pelvic LN metastasis at radical prostatectomy.

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Acknowledgements

This study was funded by the National Natural Science Foundation of China (Grant Numbers: 81672546, 81602253, and 81872083) and Joint Fund of Peking University First Hospital. We thank the entire staff of the Department of Urology, Peking University First Hospital.

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  1. These authors contributed equally: Cong Huang, Gang Song

Authors and Affiliations

  1. Department of Urology, Peking University First Hospital, Beijing, 100034, China

    Cong Huang, Gang Song, Guangjie Ji, Zhengqing Bao, Peng Hong, Yicong Du, Qun He, Shiming He, Yanqing Gong & Liqun Zhou

  2. Institute of Urology, National Urological Cancer Center of China, Peking University, Beijing, 100034, China

    Cong Huang, Gang Song, Guangjie Ji, Zhengqing Bao, Peng Hong, Yicong Du, Qun He, Shiming He, Yanqing Gong & Liqun Zhou

  3. Department of Radiology, Peking University First Hospital, Beijing, 10034, China

    Huihui Wang, Zhiyong Lin, He Wang & Xiaoying Wang

  4. Department of Urology, Yankuang Group General Hospital, Zoucheng, 273500, Shandong, China

    Shouyi Zhang

  5. Department of Urology, Shijiazhuang First Hospital, Shijiazhuang, 050011, Hebei, China

    Yuanshan Guo

  6. Department of Urology, Lishui Central Hospital, The Fifth Affiliated Hospital, Wenzhou Medical University, Lishui, 323000, Zhejiang, China

    Jie Li

  7. Department of Ultrasound, Peking University First Hospital, Beijing, 100034, China

    Peng Li

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Contributions

CH and GS contributed equally to this work. GS, XYW, and LQZ conceived and designed the study. CH, HHW, ZYL, GJJ, SYZ, YSG, JL, ZQB, PH, and YCD collected the data. HHW and ZYL analyzed mpMRI results. CH, PL, QH, SMH, and YQG analyzed and interpreted the data. CH and GS drafted the manuscript. GS revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gang Song, Xiaoying Wang or Liqun Zhou.

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Huang, C., Song, G., Wang, H. et al. Preoperative PI-RADS Version 2 scores helps improve accuracy of clinical nomograms for predicting pelvic lymph node metastasis at radical prostatectomy. Prostate Cancer Prostatic Dis 23, 116–126 (2020). https://doi.org/10.1038/s41391-019-0164-z

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