A machine learning‐assisted decision‐support model to better identify patients with prostate cancer requiring an extended pelvic lymph node dissection

OBJECTIVES: To develop a machine learning (ML)-assisted model to identify candidates for extended pelvic lymph node dissection (ePLND) in prostate cancer by integrating clinical, biopsy, and precisely defined magnetic resonance imaging (MRI) findings. PATIENTS AND METHODS: In all, 248 patients treated with radical prostatectomy and ePLND or PLND were included. ML-assisted models were developed from 18 integrated features using logistic regression (LR), support vector machine (SVM), and random forests (RFs). The models were compared to the Memorial SloanKettering Cancer Center (MSKCC) nomogram using receiver operating characteristic-derived area under the curve (AUC) calibration plots and decision curve analysis (DCA). RESULTS: A total of 59/248 (23.8%) lymph node invasions (LNIs) were identified at surgery. The predictive accuracy of the ML-based models, with (+) or without (-) MRI-reported LNI, yielded similar AUCs (RFs(+) /RFs(-) : 0.906/0.885; SVM(+) /SVM(-) : 0.891/0.868; LR(+) /LR(-) : 0.886/0.882) and were higher than the MSKCC nomogram (0.816; P /=50% of ePLNDs with a risk of missing <3% of LNIs.