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Volume 23, Issue 1 (January 2021) 23, 41–46; 10.4103/aja.aja_19_20

Development and validation of a nomogram including lymphocyte-to-monocyte ratio for initial prostate biopsy: a double-center retrospective study

Zhong-Han Zhou1, Feng Liu1, Wen-Jie Wang2, Xue Liu3, Li-Jiang Sun1, Yao Zhu4, Ding-Wei Ye4, Gui-Ming Zhang1

1 Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
2 Department of Special Inspection, Qingdao Eighth People's Hospital, Qingdao 266003, China
3 Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
4 Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China

Correspondence: Dr. DW Ye (yedingwei1963@126.com) or Dr. GM Zhang (zhangguiming9@126.com)

Date of Submission 28-Oct-2019 Date of Acceptance 16-Mar-2020 Date of Web Publication 05-May-2020


Here, we developed a prostate cancer (PCa) risk nomogram including lymphocyte-to-monocyte ratio (LMR) for initial prostate biopsy, and internal and external validation were further conducted. A prediction model was developed on a training set. Significant risk factors with P < 0.10 in multivariate logistic regression models were used to generate a nomogram. Discrimination, calibration, and clinical usefulness of the model were assessed using C-index, calibration plot, and decision curve analysis (DCA). The nomogram was re-examined with the internal and external validation set. A nomogram predicting PCa risk in patients with prostate-specific antigen (PSA) 4–10 ng ml−1 was also developed. The model displayed good discrimination with C-index of 0.830 (95% confidence interval [CI]: 0.812–0.852). High C-index of 0.864 (95% CI: 0.840–0.888) and 0.871 (95% CI: 0.861–0.881) was still reached in the internal and external validation sets, respectively. The nomogram exhibited better performance compared to the nomogram with PSA only (C-index: 0.763, 95% CI: 0.746–0.780, P < 0.001) and the nomogram with LMR excluded (C-index: 0.824, 95% CI: 0.804–0.844, P < 0.010). The calibration curve demonstrated good agreement in the internal and external validation sets. DCA showed that the nomogram was useful at the threshold probability of >4% and <99%. The nomogram predicting PCa risk in patients with PSA 4–10 ng ml−1 also displayed good calibration and discrimination performance (C-index: 0.734, 95% CI: 0.708–0.760). This nomogram incorporating age, PSA, digital rectal examination, abnormal imaging signals, PSA density, and LMR could be used to facilitate individual PCa risk prediction in initial prostate biopsy.

Keywords: lymphocyte-to-monocyte ratio; nomogram; prostate biopsy; prostate cancer

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