Malte Rieken1,2,3, Stephen A Boorjian4, Luis A Kluth2,5, Umberto Capitanio6, Alberto Briganti6, R Houston Thompson4, Bradley C Leibovich4, Laura-Maria Krabbe7, Vitaly Margulis7, Jay D Raman8, Mikhail Regelman8, Pierre I Karakiewicz9, Morgan Rouprêt2,10, Mohammad Abufaraj1,11, Beat Foerster1,12, Mithat Gönen13, Shahrokh F Shariat14,15,16,17. 1. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. 2. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 3. University of Basel, Basel, Switzerland. 4. Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA. 5. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy. 7. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 8. Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. 9. Department of Urology, University of Montreal, Montreal, QC, Canada. 10. Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France. 11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 12. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland. 13. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 14. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. sfshariat@gmail.com. 15. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. sfshariat@gmail.com. 16. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. sfshariat@gmail.com. 17. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. sfshariat@gmail.com.
Abstract
OBJECTIVES: To develop and externally validate a model that quantifies the likelihood that a pathologically node-negative patient with clear cell renal cell carcinoma (cRCC) has, indeed, no lymph node metastasis (LNM). PATIENTS AND METHODS: Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. For external validation, we used data from 2270 patients in the Surveillance, Epidemiology and End Results (SEER) database. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node negative as a function of the number of examined lymph nodes (LNs). RESULTS: The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD 6.6; interquartile range, IQR 7.0) in the development cohort and 5.6 and 2.0 (SD 8.6, IQR 5.0) in the validation cohort, respectively. The probability of missing a positive LN decreased with increasing number of LNs examined. In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman grade. CONCLUSIONS: The number of examined LNs needed for adequate nodal staging in cRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patient counseling, decision-making regarding risk-stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.
OBJECTIVES: To develop and externally validate a model that quantifies the likelihood that a pathologically node-negative patient with clear cell renal cell carcinoma (cRCC) has, indeed, no lymph node metastasis (LNM). PATIENTS AND METHODS: Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. For external validation, we used data from 2270 patients in the Surveillance, Epidemiology and End Results (SEER) database. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node negative as a function of the number of examined lymph nodes (LNs). RESULTS: The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD 6.6; interquartile range, IQR 7.0) in the development cohort and 5.6 and 2.0 (SD 8.6, IQR 5.0) in the validation cohort, respectively. The probability of missing a positive LN decreased with increasing number of LNs examined. In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman grade. CONCLUSIONS: The number of examined LNs needed for adequate nodal staging in cRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patient counseling, decision-making regarding risk-stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.
Authors: Umberto Capitanio; Frank Becker; Michael L Blute; Peter Mulders; Jean-Jacques Patard; Paul Russo; Urs E Studer; Hein Van Poppel Journal: Eur Urol Date: 2011-09-13 Impact factor: 20.096
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Authors: Borje Ljungberg; Karim Bensalah; Steven Canfield; Saeed Dabestani; Fabian Hofmann; Milan Hora; Markus A Kuczyk; Thomas Lam; Lorenzo Marconi; Axel S Merseburger; Peter Mulders; Thomas Powles; Michael Staehler; Alessandro Volpe; Axel Bex Journal: Eur Urol Date: 2015-01-21 Impact factor: 20.096
Authors: Umberto Capitanio; Claudio Jeldres; Jean-Jacques Patard; Paul Perrotte; Laurent Zini; Alexandre de La Taille; Vincenzo Ficarra; Luca Cindolo; Karim Bensalah; Walter Artibani; Jacques Tostain; Antoine Valeri; Richard Zigeuner; Arnaud Méjean; Jean Luc Descotes; Eric Lechevallier; Peter F Mulders; Herve Lang; Didier Jacqmin; Pierre I Karakiewicz Journal: BJU Int Date: 2008-10-16 Impact factor: 5.588
Authors: Pierre I Karakiewicz; Nazareno Suardi; Umberto Capitanio; Hendrik Isbarn; Claudio Jeldres; Paul Perrotte; Maxine Sun; Vincenzo Ficarra; Richard Zigeuner; Jacques Tostain; Arnaud Mejean; Luca Cindolo; Allan J Pantuck; Arie S Belldegrun; Laurent Zini; Alexandre de la Taille; Denis Chautard; Jean-Luc Descotes; Shahrokh F Shariat; Antoine Valeri; Peter F A Mulders; Hervé Lang; Eric Lechevallier; Jean-Jacques Patard Journal: J Urol Date: 2009-10-17 Impact factor: 7.450
Authors: Giovanni Lughezzani; Umberto Capitanio; Claudio Jeldres; Hendrik Isbarn; Shahrokh F Shariat; Philippe Arjane; Hugues Widmer; Paul Perrotte; Francesco Montorsi; Pierre I Karakiewicz Journal: Cancer Date: 2009-12-15 Impact factor: 6.860