Clinical nodal staging scores for prostate cancer: A proposal for preoperative risk assessment Journal Article
| Authors: | Kluth, L. A.; Abdollah, F.; Xylinas, E.; Rieken, M.; Fajkovic, H.; Seitz, C.; Sun, M.; Karakiewicz, P. I.; Schramek, P.; Herman, M. P.; Becker, A.; Hansen, J.; Ehdaie, B.; Loidl, W.; Pummer, K.; Lee, R. K.; Lotan, Y.; Scherr, D. S.; Seiler, D.; Ahyai, S. A.; Chun, F. K. H.; Graefen, M.; Tewari, A.; Nonis, A.; Bachmann, A.; Montorsi, F.; Gonen, M.; Briganti, A.; Shariat, S. F. |
| Article Title: | Clinical nodal staging scores for prostate cancer: A proposal for preoperative risk assessment |
| Abstract: | Background:Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status.Methods:We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes.Results:In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively.Conclusions:Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis. © 2014 Cancer Research UK. |
| Keywords: | adult; controlled study; aged; major clinical study; cancer risk; cancer staging; lymph node metastasis; pelvis lymphadenectomy; cancer model; risk assessment; prostate cancer; gleason score; preoperative period; prostatectomy; scoring system; pelvic lymph node dissection; nodal yield; human; male; priority journal; article; extended lymph node dissection; clinical nodal staging score |
| Journal Title: | British Journal of Cancer |
| Volume: | 111 |
| Issue: | 2 |
| ISSN: | 0007-0920 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2014-07-08 |
| Start Page: | 213 |
| End Page: | 219 |
| Language: | English |
| DOI: | 10.1038/bjc.2014.311 |
| PROVIDER: | scopus |
| PMCID: | PMC4102948 |
| PUBMED: | 25003663 |
| DOI/URL: | |
| Notes: | Export Date: 2 September 2014 -- CODEN: BJCAA -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work