Luis A Kluth1, Firas Abdollah2, Evanguelos Xylinas3, Malte Rieken4, Harun Fajkovic5, Maxine Sun6, Pierre I Karakiewicz6, Christian Seitz5, Paul Schramek7, Michael P Herman8, Andreas Becker9, Wolfgang Loidl10, Karl Pummer11, Alessandro Nonis12, Richard K Lee8, Yair Lotan13, Douglas S Scherr8, Daniel Seiler14, Felix K-H Chun15, Markus Graefen16, Ashutosh Tewari8, Mithat Gönen17, Francesco Montorsi2, Shahrokh F Shariat18, Alberto Briganti2. 1. Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy. 3. Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. 4. Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital of Basel, Basel, Switzerland. 5. Department of Urology, Medical University of Vienna, Vienna, Austria. 6. Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. 7. Department of Urology, Krankenhaus der Barmherzigen Brueder, Vienna, Austria. 8. Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA. 9. Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Prostate Cancer Center, Martini Clinic, Hamburg, Germany. 10. Prostate Cancer Center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria. 11. Department of Urology, Medical University of Graz, Graz, Austria. 12. University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy. 13. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 14. Department of Urology, Kantonsspital Aarau, Aarau, Switzerland. 15. Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 16. Prostate Cancer Center, Martini Clinic, Hamburg, Germany. 17. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 18. Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Division of Medical Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
Abstract
BACKGROUND: Nodal metastasis is the strongest risk factor of disease recurrence in patients with localized prostate cancer (PCa) treated with radical prostatectomy (RP). OBJECTIVE: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient is indeed free of nodal metastasis. DESIGN, SETTING, AND PARTICIPANTS: Data from patients treated with RP and pelvic lymph node dissection (PLND; n=7135) for PCa between 2000 and 2011 were analyzed. For external validation, we used data from patients (n=4209) who underwent an anatomically defined extended PLND. INTERVENTION: RP and PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We developed a novel pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative based on the number of examined nodes and the patient's characteristics. RESULTS AND LIMITATIONS: In the development and validation cohorts, the probability of missing a positive node decreases with an increasing number of nodes examined. Whereas in pT2 patients, a 90% pNSS was achieved with one single examined node in both the development and validation cohort, a similar level of nodal staging accuracy was achieved in pT3a patients by examining five and nine nodes, respectively. The pT3b/T4 patients achieved a pNSS of 80% and 70% when 17 and 20 nodes in the development and validation cohort were examined, respectively. This study is limited by its retrospective design and multicenter nature. The number of nodes removed was not directly correlated with the extent/template of PLND. CONCLUSIONS: Every patient needs PLND for accurate nodal staging. However, a one-size-fits-all approach is too inaccurate. We developed a tool that indicates a node-negative patient is indeed free of lymph node metastasis by evaluating the number of examined nodes, pT stage, RP Gleason score, surgical margins, and prostate-specific antigen. This tool may help in postoperative decision making.
BACKGROUND: Nodal metastasis is the strongest risk factor of disease recurrence in patients with localized prostate cancer (PCa) treated with radical prostatectomy (RP). OBJECTIVE: To develop a model that allows quantification of the likelihood that a pathologically node-negative patient is indeed free of nodal metastasis. DESIGN, SETTING, AND PARTICIPANTS: Data from patients treated with RP and pelvic lymph node dissection (PLND; n=7135) for PCa between 2000 and 2011 were analyzed. For external validation, we used data from patients (n=4209) who underwent an anatomically defined extended PLND. INTERVENTION: RP and PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We developed a novel pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative based on the number of examined nodes and the patient's characteristics. RESULTS AND LIMITATIONS: In the development and validation cohorts, the probability of missing a positive node decreases with an increasing number of nodes examined. Whereas in pT2 patients, a 90% pNSS was achieved with one single examined node in both the development and validation cohort, a similar level of nodal staging accuracy was achieved in pT3a patients by examining five and nine nodes, respectively. The pT3b/T4 patients achieved a pNSS of 80% and 70% when 17 and 20 nodes in the development and validation cohort were examined, respectively. This study is limited by its retrospective design and multicenter nature. The number of nodes removed was not directly correlated with the extent/template of PLND. CONCLUSIONS: Every patient needs PLND for accurate nodal staging. However, a one-size-fits-all approach is too inaccurate. We developed a tool that indicates a node-negative patient is indeed free of lymph node metastasis by evaluating the number of examined nodes, pT stage, RP Gleason score, surgical margins, and prostate-specific antigen. This tool may help in postoperative decision making.
Authors: Malte Rieken; Stephen A Boorjian; Luis A Kluth; Umberto Capitanio; Alberto Briganti; R Houston Thompson; Bradley C Leibovich; Laura-Maria Krabbe; Vitaly Margulis; Jay D Raman; Mikhail Regelman; Pierre I Karakiewicz; Morgan Rouprêt; Mohammad Abufaraj; Beat Foerster; Mithat Gönen; Shahrokh F Shariat Journal: World J Urol Date: 2018-11-07 Impact factor: 4.226
Authors: L A Kluth; F Abdollah; E Xylinas; M Rieken; H Fajkovic; C Seitz; M Sun; P I Karakiewicz; P Schramek; M P Herman; A Becker; J Hansen; B Ehdaie; W Loidl; K Pummer; R K Lee; Y Lotan; D S Scherr; D Seiler; S A Ahyai; F K-H Chun; M Graefen; A Tewari; A Nonis; A Bachmann; F Montorsi; M Gönen; A Briganti; S F Shariat Journal: Br J Cancer Date: 2014-07-08 Impact factor: 7.640