Pierre I. Karakiewicz, Cancer prognostics and Health Outcome Unit, University of Montreal Heath Center (CHUM), 1058, rue St-Denis, Montreal, Quebec, Canada, H2X 3J4. e-mail: [email protected]Search for more papers by this author

Alberto Briganti,

Alberto Briganti

Department of Urology, Vita-Salute University, Milan, Italy,

Cancer Prognostics and Health Outcomes Unit, University of Montreal, Canada, and

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Felix K-H. Chun,

Felix K-H. Chun

Cancer Prognostics and Health Outcomes Unit, University of Montreal, Canada, and

Department of Urology, University of Hamburg, Hamburg, Germany

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Andrea Salonia,

Andrea Salonia

Department of Urology, Vita-Salute University, Milan, Italy,

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Andrea Gallina,

Andrea Gallina

Department of Urology, Vita-Salute University, Milan, Italy,

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Elena Farina,

Elena Farina

Department of Urology, Vita-Salute University, Milan, Italy,

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Luigi F. Da Pozzo,

Luigi F. Da Pozzo

Department of Urology, Vita-Salute University, Milan, Italy,

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Patrizio Rigatti,

Patrizio Rigatti

Department of Urology, Vita-Salute University, Milan, Italy,

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Francesco Montorsi,

Francesco Montorsi

Department of Urology, Vita-Salute University, Milan, Italy,

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Pierre I. Karakiewicz,

Corresponding Author

Pierre I. Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal, Canada, and

First published: 26 June 2006

https://doi.org/10.1111/j.1464-410X.2006.06318.x

Citations: 141

AB and FKHC contributed equally to this paper

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Abstract

OBJECTIVE

To develop a multivariate nomogram to predict the rate of lymph node invasion (LNI) in patients with clinically localized prostate cancer according to the extent of extended pelvic lymphadenectomy (PLND), which is associated with significantly higher rate of LNI.

PATIENTS AND METHODS

The study comprised 781 consecutive patients (median age 66.6 years, range 45–85) treated with PLND and radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Their median (range) prostate-specific antigen (PSA) level was 7 (1.03–49.91) ng/mL, and their clinical stages were T1c in 433 (55.4%), T2 in 328 (42%) and T3 in 20 (2.6%). Biopsy Gleason sums were ≤ 6 in 514 (65.8%), 7 in 204 (26.1%) and 8–10 in 63 (8.1%). Multivariate logistic regression models were used to test the association between predictors including PSA level, biopsy Gleason sum, clinical stage, number of nodes removed and the rate of LNI. Finally, regression coefficients were used to develop a nomogram, which was internally validated with 200 bootstrap re-samples.

RESULTS

The median (range) number of lymph nodes removed was 14 (2–40); LNI was detected in 71 patients (9.1%). The univariate predictive accuracy for total PSA level, clinical stage, biopsy Gleason sum and number of total nodes removed and examined was 64.2%, 59.8%, 74% and 62.9%, respectively. Except for PSA (P = 0.2), all variables were statistically significant multivariate predictors of LNI at RRP (P ≤ 0.001). A nomogram based on clinical stage, PSA level, biopsy Gleason sum and the number of total lymph nodes removed was 78.6% accurate, and 1.8% more accurate than a nomogram without the number of removed lymph nodes.

CONCLUSIONS

The extent of PLND is directly related to the probability of LNI. The risk of LNI increases linearly, and is proportional to the number of nodes removed and examined. The effect of the increased probability of LNI is weighted more heavily in men with more advanced clinical stage and grade.

REFERENCES

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Citing Literature

Volume98, Issue4

October 2006

Pages 788-793

Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer

Abstract

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSIONS

REFERENCES

Citing Literature

References

Information

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Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer

Abstract

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSIONS

REFERENCES

Citing Literature

References

Related

Information