Risk Factors for Lymph Node Metastasis and Construction with Validation of a Nomogram Prediction Model in Robot-Assisted Radical Prostatectomy
Zhao Kun
An Ziyan
Shao Jinpeng
Song Yong
Fu Weijun
Abstract：Objective:To investigate the risk factors for pelvic lymph node metastasis in prostate cancer pa-tients,construct a nomogram prediction model for pelvic lymph node metastasis,and perform external validation.Methods:This retrospective study collected clinical data from 437 prostate cancer patients who underwent robot-as-sisted radical prostatectomy(RARP)at the First Medical Center of the General Hospital of the People's Liberation Army from January 2017 to December 2020 as the training set.Clinical data from 74 prostate cancer patients who un-derwent RARP at the Third Medical Center of the General Hospital of the People's Liberation Army from January 2021 to December 2022 were used as the external validation set.Based on the postoperative pathological results,the training set was divided into two groups:the pelvic lymph node metastasis group(n=48)and the non-metastasis group(n=389).Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for pelvic lymph node metastasis.A nomogram was constructed and externally validated.Results:There were no statistically significant differences in the clinical characteristics between the training and validation sets.Univariate and multivariate logistic regression analyses showed that Gleason score(P=0.017),total prostate-specific antigen(tPSA)level(P<0.001),percentage of positive core biopsies(P<0.001),and clinical stage(P<0.001)were in-dependently associated with lymph node metastasis in the training set.The area under the receiver operating character-istic curve(AUC)for the training set was 0.787(95%CI:0.704-0.807),and for the external validation set,it was 0.774(95%CI:0.613-0.953).Calibration curves demonstrated that the predicted probabilities of lymph node metasta-sis by the nomogram were consistent with the actual outcomes(training set C-index:0.787).Decision curve analysis indicated that the model provided good net benefit.Conclusion:The constructed nomogram for predicting the proba-bility of pelvic lymph node metastasis was simple,practical,and highly accurate,as confirmed by external validation.This nomogram can serve as a valuable reference for clinical decision-making.
Keywords：prostate cancerrobot-assisted radical prostatectomylymph node metastasisprediction models
Publication Date：2025-06-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 176-182 )