Clinical Research

Construction and clinical validation of a machine learning⁃based nomogram model for predicting lymphatic leakage following radical prostatectomy

  • Xiudong YANG ,
  • Xing LIU ,
  • Xin LIU ,
  • Yan JIANG ,
  • Wei WANG ,
  • Zongbin HE ,
  • Sha HUANG ,
  • Meihong WEN ,
  • Yazhen. LIU
Expand
  • *.Department of Urology,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,Guangdong,China

Received date: 2025-06-03

  Online published: 2025-11-13

Abstract

Objective To identify risk factors associated with lymphatic leakage after laparoscopic radical prostatectomy (LRP) and to develop a machine learning?based nomogram for predicting such outcomes to support clinical prevention strategies. Methods We retrospectively analyzed perioperative data from 248 patients who underwent radical prostatectomy for prostate cancer between January 2020 and January 2024. Independent risk factors were identified through univariate and multivariate logistic regression analyses. A predictive model was developed, and its diagnostic performance was assessed by the area under the receiver operating characteristic curve (AUC). Five?fold cross?validation was performed to evaluate the model′s generalizability. A nomogram was subsequently constructed to facilitate individualized risk quantification. Results Among the 248 patients, 89 (35.9%) developed lymphatic leakage, while 159 (64.1%) did not. Independent risk factors for lymphatic leakage included intraoperative lymph node dissection (OR = 5.415, 95%CI: 2.167 ~ 13.532, P < 0.001), intraoperative plasma transfusion (OR = 2.952, 95%CI: 1.524 ~ 5.718, P = 0.001), and postoperative fasting duration of ≥ 2 days (OR = 1.412, 95%CI: 1.089 ~ 1.829, P = 0.009). The predictive model showed good discrimination and calibration (AUC = 0.711, 95%CI: 0.647 ~ 0.776, P < 0.001; sensitivity: 0.764; specificity: 0.597). Model robustness was confirmed through five?fold cross?validation (training set AUC = 0.822; test set AUC = 0.829). The nomogram provided a clinically useful tool for quantifying individual risk of lymphatic leakage. Conclusions Intraoperative lymph node dissection, plasma transfusion, and postoperative fasting lasting ≥ 2 days are independent risk factors for lymphatic leakage following radical prostatectomy. The validated predictive model demonstrates favorable clinical utility.

Cite this article

Xiudong YANG , Xing LIU , Xin LIU , Yan JIANG , Wei WANG , Zongbin HE , Sha HUANG , Meihong WEN , Yazhen. LIU . Construction and clinical validation of a machine learning⁃based nomogram model for predicting lymphatic leakage following radical prostatectomy[J]. The Journal of Practical Medicine, 2025 , 41(21) : 3378 -3384 . DOI: 10.3969/j.issn.1006-5725.2025.21.012

References

[1] SEKHOACHA M, RIET K, MOTLOUNG P, et al. Prostate Cancer Review: Genetics, Diagnosis, Treatment Options, and Alternative Approaches [J]. Molecules, 2022, 27(17): 5730. doi:10.3390/molecules27175730
[2] 杨梦霞, 王武亮, 赵虎. 妇科恶性肿瘤术后淋巴漏的危险因素分析[J]. 实用医学杂志, 2017, 33(6): 953-956.
[3] BHATIA H, AGARWAL P, KAUR R, et al. Congenital Peri-Lymphatic Fistula: Is CT Imaging Enough? [J]. Indian J Otolaryngol Head Neck Surg, 2023, 75(4): 4148-4150. doi:10.1007/s12070-023-03893-0
[4] KIM W T, HAM W S, KOO K C,et al. Efficacy of octreotide for management of lymphorrhea after pelvic lymph node dissection in radical prostatectomy [J]. Urology, 2010, 76(2): 398-401. doi:10.1016/j.urology.2009.04.104
[5] KAMIYA N, NORO T, OKAZAKI T, et al. Multidisciplinary Treatment for Lymphorrhea and Chylorrhea Following Lymph Node Dissection for Genitourinary Cancer [J/OL]. Cancers, 2025, 17(4): 592. doi:10.3390/cancers17040592
[6] 熊洪涛,庄永青,傅小宽,等. 腹股沟区淋巴漏治疗的研究进展 [J]. 中国临床解剖学杂志, 2021, 39(5): 627-629.
[7] INOUE M, NAKATSUKA S, YASHIRO H, et al. Lymphatic intervention for various types of lymphorrhea: Access and treatment [J]. Radiographics, 2016, 36(7): 2199?2211. doi:10.1148/rg.2016160053
[8] ZHANG W, JI L, WANG X, et al. Nomogram Predicts Risk and Prognostic Factors for Bone Metastasis of Pancreatic Cancer: A Population-Based Analysis [J]. Front Endocrinol (Lausanne), 2021, 12: 752176. doi:10.3389/fendo.2021.752176
[9] FOSSATI N, WILLEMSE P M, VAN DEN BROECK T, et al. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review [J]. Eur Urol, 2017, 72(1): 84-109. doi:10.1016/j.eururo.2016.12.003
[10] GOLER C, MAY M, WEIKERT S, et al. Long-Term FoLLow-Up of Peritoneal Interposition Flap in Symptomatic Lymphocele Reduction foLLowing Robot-Assisted Radical Prostatectomy: Insights from the PIANOFORTE Trial [J]. Cancers (Basel), 2024, 16(10): 1932. doi:10.3390/cancers16101932
[11] NEUBERGER M, KOWALEWSKI K F, SIMON V, et al. Peritoneal Flap for Lymphocele Prophylaxis Following Robotic-assisted Radical Prostatectomy with Lymph Node Dissection: The Randomised Controlled Phase 3 PELYCAN Trial [J/OL]. Eur Urol Oncol, 2024, 7(1): 53-62. doi:10.1016/j.euo.2023.07.009
[12] STUDENT V J, TUDOS Z, STUDENTOVA Z, et al. Effect of Peritoneal Fixation (PerFix) on Lymphocele Formation in Robot-assisted Radical Prostatectomy with Pelvic Lymphadenectomy: Results of a Randomized Prospective Trial [J/OL]. European urology, 2023, 83(2): 154-162. doi:10.1016/j.eururo.2022.07.027
[13] SU S, WANG J, LEI Y, et al. The efficacy of peritoneal flap fixation on symptomatic lymphocele formation following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: A systematic review and meta-analysis [J/OL]. Int J Surg, 2024, 110(2): 1172-1182. doi:10.1097/js9.0000000000000893
[14] CHUNG D Y, KANG D H. Cytoreductive prostatectomy may improve oncological outcomes in patients with oligometastatic prostate cancer: An updated systematic review and meta-analysis [J]. Investig Clin Urol, 2023, 64(3): 242-254. doi:10.4111/icu.20230058
[15] DITONNO F, MANFREDI C, FRANCO A, et al. Impact of peritoneal reconfiguration on lymphocele formation after robot-assisted radical prostatectomy with pelvic lymph node dissection: A systematic review and meta-analysis of randomized controlled trials [J/OL]. Prostate Cancer Prostatic Dis, 2024, 27(4): 635-644. doi:10.1038/s41391-023-00744-5
[16] DE HERTOGH O, LE BIHAN G, ZILLI T, et al. Consensus Delineation Guidelines for Pelvic Lymph Node Radiation Therapy of Prostate Cancer: On Behalf of the Francophone Group of Urological Radiation Therapy (GFRU) [J]. Int J Radiat Oncol Biol Phys, 2024, 118(1): 29-40. doi:10.1016/j.ijrobp.2023.07.020
[17] SOUZA-SMITH F M, MOLINA P E, MAIYA R. Chronic alcohol feeding alters lymph and plasma proteome in a rodent model [J]. Life Sci, 2023, 327: 121818. doi:10.1016/j.lfs.2023.121818
[18] DEBRAH L B, GYASI C, AHIADORME M, et al. Association of haemato-biochemical indices and blood composite ratios with microfilaridermia in Onchocerciasis patients [J]. BMC Infect Dis, 2024, 24(1): 384-384. doi:10.1186/s12879-024-09278-0
[19] WU E J, KABIR T, ZHAO J J, et al. MinimaLLy Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy: A Meta-Analysis [J]. World J Surg, 2022, 46(1): 235-245. doi:10.1007/s00268-021-06328-5
[20] LUZZAGO S, PALUMBO C, ROSIELLO G, et al. Metabolic syndrome predicts worse perioperative outcomes in patients treated with radical prostatectomy for non-metastatic prostate cancer [J]. Surg Oncol, 2021, 37: 101519. doi:10.1016/j.suronc.2020.12.013
[21] 张苏杰, 赵卫红, 于路平, 等. 伴多发淋巴结肿大的乏脂型血管平滑肌脂肪瘤并发术后顽固性淋巴瘘1例报道及文献回顾 [J]. 北京大学学报(医学版), 2018, 50(4): 717-721.
[22] ERDEMIR A, D KD K M, RA?A K. Thoracic Duct Embolization for Postoperative Lymphatic Fistula [J]. Case Rep Surg, 2022, 2022: 7510793. doi:10.1155/2022/7510793
[23] SMITH R, HIGGINSON J, BREIK O, et al. Nutritional management of chyle leak after head and neck surgery: A systematic review and proposed protocol for management [J]. Oral MaxiLLofac Surg, 2024, 28(1): 51-62. doi:10.1007/s10006-023-01152-8
[24] ZHU Q, YANG Q, SHEN L, et al. Impact of Sequential Lipid Meals on Lymphatic Lipid Absorption and Transport in Rats [J]. Genes, 2022, 13(2): 277. doi:10.3390/genes13020277
[25] SHYR B U, SHYR B S, CHEN S C, et al. Operative results and patient satisfaction after robotic pancreaticoduodenectomy [J]. Asian J Surg, 2020, 43(4): 519-525. doi:10.1016/j.asjsur.2019.08.012
Outlines

/