Evanguelos Xylinas1, Luis Kluth2, Malte Rieken3, Morgan Rouprêt4, Bashir Al Hussein Al Awamlh5, Thomas Clozel5, Maxine Sun6, Pierre I Karakiewicz6, Mithat Gonen7, Shahrokh F Shariat8. 1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY; Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France. 2. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY; Department of Urology, University Hospital Basel, Basel, Switzerland. 4. Department of Urology, Pitie-Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France. 5. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY. 6. Department of Urology, University of Montreal, Montreal, Quebec, Canada. 7. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY. 8. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
Abstract
OBJECTIVES: To externally validate our previously developed pathological nodal staging model (pNSS) that allows quantification of the likelihood that a patient with pathologic node-negative status has, indeed, no lymph node metastasis (LNM). PATIENTS AND METHODS: We analyzed data from 2,768 patients treated with radical nephroureterectomy (RNU) and lymph node dissection (LND) using the Surveillance, Epidemiology, and End Results database from 1988 to 2010. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a new pNSS. Then, we compared these findings with those of the initial cohort. RESULTS: The mean and median numbers of lymph node (LN) removed were 5 and 2, respectively (interquartile range = 5) in the validation cohort, though 66.5% of the patients (n = 1814) were pN0. Similar to the development cohort, the probability of missing a LNM decreased as the number of nodes examined increased in the validation cohort. If only a single node was examined, 35% of patients would be misclassified as pN0 while harboring LNM. Even when 5 nodes were examined, 8% would be misclassified. The probability of having a positive node increased with advancing pathological T stage in both the cohorts. Patients with pT0-Ta-Tis-T1 disease in both cohorts would have more than a 95% chance of a correct pathologic nodal staging with 2 examined nodes. However, if a patient has pT3-T4 disease, more than 12 examined LNs are needed to reach 95% accuracy. CONCLUSIONS: We confirmed that the number of examined nodes needed for adequate staging depends on pT category. We externally validated our previous pNSS in a population-based database, which could help in the clinical decision-making regarding adjuvant chemotherapy administration.
OBJECTIVES: To externally validate our previously developed pathological nodal staging model (pNSS) that allows quantification of the likelihood that a patient with pathologic node-negative status has, indeed, no lymph node metastasis (LNM). PATIENTS AND METHODS: We analyzed data from 2,768 patients treated with radical nephroureterectomy (RNU) and lymph node dissection (LND) using the Surveillance, Epidemiology, and End Results database from 1988 to 2010. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a new pNSS. Then, we compared these findings with those of the initial cohort. RESULTS: The mean and median numbers of lymph node (LN) removed were 5 and 2, respectively (interquartile range = 5) in the validation cohort, though 66.5% of the patients (n = 1814) were pN0. Similar to the development cohort, the probability of missing a LNM decreased as the number of nodes examined increased in the validation cohort. If only a single node was examined, 35% of patients would be misclassified as pN0 while harboring LNM. Even when 5 nodes were examined, 8% would be misclassified. The probability of having a positive node increased with advancing pathological T stage in both the cohorts. Patients with pT0-Ta-Tis-T1 disease in both cohorts would have more than a 95% chance of a correct pathologic nodal staging with 2 examined nodes. However, if a patient has pT3-T4 disease, more than 12 examined LNs are needed to reach 95% accuracy. CONCLUSIONS: We confirmed that the number of examined nodes needed for adequate staging depends on pT category. We externally validated our previous pNSS in a population-based database, which could help in the clinical decision-making regarding adjuvant chemotherapy administration.
Authors: Maria Vassilakopoulou; Thibault de la Motte Rouge; Pierre Colin; Adil Ouzzane; David Khayat; Meletios-Athanasios Dimopoulos; Christos A Papadimitriou; Aristotle Bamias; Géraldine Pignot; François Xavier Nouhaud; Sophie Hurel; Laurent Guy; Pierre Bigot; Mathieu Roumiguié; Morgan Rouprêt Journal: Cancer Date: 2011-06-02 Impact factor: 6.860
Authors: Eugene K Cha; Shahrokh F Shariat; Matthias Kormaksson; Giacomo Novara; Thomas F Chromecki; Douglas S Scherr; Yair Lotan; Jay D Raman; Wassim Kassouf; Richard Zigeuner; Mesut Remzi; Karim Bensalah; Alon Weizer; Eiji Kikuchi; Christian Bolenz; Marco Roscigno; Theresa M Koppie; Casey K Ng; Hans-Martin Fritsche; Kazumasa Matsumoto; Thomas J Walton; Behfar Ehdaie; Stefan Tritschler; Harun Fajkovic; Juan I Martínez-Salamanca; Armin Pycha; Cord Langner; Vincenzo Ficarra; Jean-Jacques Patard; Francesco Montorsi; Christopher G Wood; Pierre I Karakiewicz; Vitaly Margulis Journal: Eur Urol Date: 2012-01-23 Impact factor: 20.096
Authors: Faysal A Yafi; Simon Tanguay; Ricardo Rendon; Niels Jacobsen; Adrian Fairey; Jonathan Izawa; Anil Kapoor; Peter Black; Louis Lacombe; Joe Chin; Alan So; Jean-Baptiste Lattouf; David Bell; Yves Fradet; Fred Saad; Edward Matsumoto; Darrel Drachenberg; Ilias Cagiannos; Wassim Kassouf Journal: Urol Oncol Date: 2013-02-18 Impact factor: 3.498
Authors: Shahrokh F Shariat; Behfar Ehdaie; Michael Rink; Eugene K Cha; Robert S Svatek; Thomas F Chromecki; Harun Fajkovic; Giacomo Novara; Scott G David; Siamak Daneshmand; Yves Fradet; Yair Lotan; Arthur I Sagalowsky; Thomas Clozel; Patrick J Bastian; Wassim Kassouf; Hans-Martin Fritsche; Maximilian Burger; Jonathan I Izawa; Derya Tilki; Firas Abdollah; Felix K Chun; Guru Sonpavde; Pierre I Karakiewicz; Douglas S Scherr; Mithat Gonen Journal: Eur Urol Date: 2011-10-21 Impact factor: 20.096
Authors: Morgan Rouprêt; Marko Babjuk; Eva Compérat; Richard Zigeuner; Richard Sylvester; Max Burger; Nigel Cowan; Andreas Böhle; Bas W G Van Rhijn; Eero Kaasinen; Joan Palou; Shahrokh F Shariat Journal: Eur Urol Date: 2013-03-19 Impact factor: 20.096
Authors: Christian Bolenz; Shahrokh F Shariat; Mario I Fernández; Vitaly Margulis; Yair Lotan; Pierre Karakiewicz; Mesut Remzi; Eiji Kikuchi; Richard Zigeuner; Alon Weizer; Francesco Montorsi; Karim Bensalah; Christopher G Wood; Marco Roscigno; Cord Langner; Theresa M Koppie; Jay D Raman; Shuji Mikami; Maurice Stephan Michel; Philipp Ströbel Journal: BJU Int Date: 2008-10-16 Impact factor: 5.588
Authors: Nicholas J Hellenthal; Shahrokh F Shariat; Vitaly Margulis; Pierre I Karakiewicz; Marco Roscigno; Christian Bolenz; Mesut Remzi; Alon Weizer; Richard Zigeuner; Karim Bensalah; Casey K Ng; Jay D Raman; Eiji Kikuchi; Francesco Montorsi; Mototsugu Oya; Christopher G Wood; Mario Fernandez; Christopher P Evans; Theresa M Koppie Journal: J Urol Date: 2009-07-17 Impact factor: 7.450
Authors: Morgan Rouprêt; Vincent Hupertan; Thomas Seisen; Pierre Colin; Evanguelos Xylinas; David R Yates; Harun Fajkovic; Yair Lotan; Jay D Raman; Richard Zigeuner; Mesut Remzi; Christian Bolenz; Giacomo Novara; Wassim Kassouf; Adil Ouzzane; François Rozet; Olivier Cussenot; Juan I Martinez-Salamanca; Hans-Martin Fritsche; Thomas J Walton; Christopher G Wood; Karim Bensalah; Pierre I Karakiewicz; Francesco Montorsi; Vitaly Margulis; Shahrokh F Shariat Journal: J Urol Date: 2012-10-24 Impact factor: 7.450