Development and evaluation of a lymph node invasion risk prediction model in intermediate- and high-risk prostate cancer patients

Authors

  • Håkon Ramberg Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway https://orcid.org/0000-0002-5434-6029
  • Manuela Zucknick Oslo Center for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway https://orcid.org/0000-0003-1317-7422
  • Francesco Barletta Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
  • Petter Davik Department of Urology, St Olavs Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  • Åsmund Nybøen Department of Pathology, Oslo University Hospital, Oslo, Norway
  • Lars Magne Eri Department of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Sivanthe Sivanesan Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Knut Håkon Hole Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
  • Tord Hompland Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
  • Stian Ole Prestbakk Faculty of Medicine, University of Oslo, Oslo, Norway
  • Giorgio Gandaglia Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
  • Tone Frost Bathen Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
  • Alberto Briganti Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
  • Viktor Berge Department of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Kristin Austild Tasken Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway https://orcid.org/0000-0001-5530-4915

DOI:

https://doi.org/10.2340/1651-226X.2025.43970

Keywords:

Prostate cancer, Prediction model, Bayesian logistic regression, Lymph node invasion, Pelvic lymph node dissection

Abstract

Background and purpose: Many prostate cancer patients undergoing pelvic lymph node dissection (PLND) have no sign of lymph node invasion (LNI) during final pathological assessment. To improve preoperative staging accuracy, we developed the Oslo model, which estimates the risk of LNI based on clinical, histopathological, and magnetic resonance imaging (MRI) variables.

Patients/materials and methods: We utilized data from 903 prostate cancer patients treated at Oslo University Hospital (OUS) to develop the model using Bayesian logistic regression. The Oslo model was validated with data from 189 patients at IRCCS Ospedale San Raffaele (HRS), 157 from St. Olav’s Hospital, and 231 from OUS. We assessed its performance against the Memorial Sloan Kettering Cancer Centre (MSKCC) and Briganti 2019 nomograms using metrics like AUC, R², decision curve analysis, and calibration plots.

Results: The Oslo model outperformed Briganti 2019, demonstrating a higher net benefit and a 10% reduction in interventions at a 7% cutoff. Key variables included clinical T stage on MRI, Prostate Specific Antigen (PSA), prostate volume, International Society of Urological Pathology grade group, and maximum lesion length on MRI. Validation showed strong reliability in the OUS and HRS cohorts but weaker performance in the St. Olav’s cohort. The AUCs were 77% for the Oslo model, 74% for Briganti 2019, and 66% for MSKCC. Limitations include small and heterogeneous validation cohorts.

Interpretation: The Oslo model enhances predictive performance in intermediate- and high-risk patients using easily accessible clinical and MRI data, potentially reducing unnecessary PLND interventions and assisting clinicians in treatment decision-making.

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Author Biographies

Håkon Ramberg, Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway

Department of Tumor Biology, Institute for Cancer Research Lab manager

Manuela Zucknick, Oslo Center for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway

Oslo Center for Biostatistics and Epidemiology

Kristin Austild Tasken, Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospita Institute of Clinical Medicine, University of Oslo

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2025-10-22

How to Cite

Ramberg, H., Zucknick, M., Barletta, F., Davik, P., Nybøen, Åsmund, Eri, L. M., … Austild Tasken, K. (2025). Development and evaluation of a lymph node invasion risk prediction model in intermediate- and high-risk prostate cancer patients. Acta Oncologica, 64, 1446–1454. https://doi.org/10.2340/1651-226X.2025.43970

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Vol. 64 (2025): Acta Oncologica

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Original article

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Copyright (c) 2025 Håkon Ramberg, Manuela Zucknick, Francesco Barletta, Petter Davik, Åsmund Nybøen, Lars Magne Eri, Sivanthe Sivanesan, Knut Håkon Hole, Tord Hompland, Stian Ole Prestbakk, Giorgio Gandaglia, Tone Frost Bathen, Alberto Briganti, Viktor Berge, Kristin Austild Tasken

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