637 656
threshold is used. The 7% cutoff of the novel nomogram
would result in a higher number of ePLNDs spared (69% vs
66%), with a similar number of LNIs missed (1.5% vs 1.8%)
compared with the MSKCC nomogram
( Table 4 ).
3.4.
Sensitivity analyses
Supplementary Table 2 depicts the characteristics of
individuals excluded due to incomplete biopsy information
[(Fig._3)TD$FIG]
0.00
0.05
0.10
0.15
0.20
0.00
0.02
0.04
0.06
0.08
0.10
Threshold probability
Net benefit
None
All
Model 1
Fig. 3 – Decision curve analyses demonstrating the net benefit associated
with the use of the novel nomogram on the detection of lymph node
invasion.
[(Fig._2)TD$FIG]
Fig. 2 – Calibration plot of observed proportion versus predicted
probability of lymph node invasions of the novel nomogram.
Table 3 – Systematic analyses of the novel Briganti nomogram-derived cutoffs used to discriminate between patients with or without
histologically confirmed lymph node invasion
Nomogram
calculated
probability of
LNI, cutoff (%)
Patients in whom
PLND is not recommended
according to the cutoff
(below cutoff)
Patients below
cutoff without
histologic LNI
Patients below
cutoff with
histologic LNI
Patients in whom
PLND is recommended
according to the cutoff
(above cutoff)
Patients above
cutoff without
histologic LNI
Patients above
cutoff with
histologic LNI
1
38 (5.6)
38 (6.3)
0 (0)
643 (94)
564 (88)
79 (100)
2
264 (39)
264 (44)
0 (0)
417 (61)
338 (81)
79 (100)
3
362 (53)
359 (60)
3 (0.8)
319 (47)
243 (76)
76 (96)
4
406 (60)
402 (67)
4 (1.0)
275 (40)
200 (72)
75 (95)
5
446 (66)
441 (73)
5 (1.1)
235 (35)
161 (69)
74 (94)
6
464 (68)
458 (76)
6 (1.3)
217 (32)
144 (66)
73 (92)
7
471 (69)
464 (77)
7 (1.5)
210 (31)
138 (66)
72 (91)
8
482 (71)
474 (79)
8 (1.7)
199 (29)
128 (64)
71 (90)
9
491 (72)
482 (80)
9 (1.8)
190 (28)
120 (63)
70 (89)
10
496 (73)
486 (81)
10 (2.0)
185 (27)
116 (63)
69 (87)
LNI = lymph node invasion; PLND = pelvic lymph node dissection.
Table 4 – Clinical implications according to treatment option (novel nomogram vs Briganti nomogram vs MSKCC nomogram)
Treatment option
Patients in whom
PLND is not recommended
according to the cutoff
(below cutoff)
Patients below
cutoff without
histologic LNI
Patients below
cutoff with
histologic LNI
Patients in whom
PLND is recommended
according to the cutoff
(above cutoff)
Patients above
cutoff without
histologic LNI
Patients above
cutoff with
histologic LNI
Novel nomogram,
7% cutoff
471 (69)
464 (99)
7 (1.5)
210 (31)
138 (66)
72 (34)
Briganti nomogram,
7% cutoff
464 (68)
454 (98)
10 (2.2)
217 (32)
148 (68)
69 (32)
MSKCC nomogram,
7% cutoff
451 (66)
443 (98)
8 (1.8)
230 (34)
159 (69)
71 (31)
LNI = lymph node invasion; MSKCC = Memorial Sloan Kettering Cancer Center; PLND = pelvic lymph node dissection.
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 6 3 2 – 6 4 0
637