373 PATHOLOGICAL NODAL STAGING SCORE FOR PROSTATE CANCER: A TOOL TO ADDRESS ADEQUATE NODAL DISSECTION IN MEN TREATED WITH RADICAL PROSTATECTOMY (2013)

You have accessJournal of UrologyProstate Cancer: Staging (II)1 Apr 2013373 PATHOLOGICAL NODAL STAGING SCORE FOR PROSTATE CANCER: A TOOL TO ADDRESS ADEQUATE NODAL DISSECTION IN MEN TREATED WITH RADICAL PROSTATECTOMY Alberto Briganti, Alessandro Nonis, Chiara Brombin, Umberto Capitanio, Andrea Gallina, Alessandro Nini, Marco Bianchi, Massimo Freschi, Claudio Doglioni, Patrizio Rigatti, Louis Kluth, Felix Chun, Shahrokh Shariat, Francesco Montorsi, and Clelia Di Serio Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Alessandro NonisAlessandro Nonis Milan, Italy More articles by this author , Chiara BrombinChiara Brombin Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Alessandro NiniAlessandro Nini Milan, Italy More articles by this author , Marco BianchiMarco Bianchi Milan, Italy More articles by this author , Massimo FreschiMassimo Freschi Milan, Italy More articles by this author , Claudio DoglioniClaudio Doglioni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , Louis KluthLouis Kluth New York, NY More articles by this author , Felix ChunFelix Chun Hamburg, Germany More articles by this author , Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author , Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author , and Clelia Di SerioClelia Di Serio Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1761AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES According to all guidelines, whenever pelvic lymph node dissection (PLND) is indicated in prostate cancer (PCa), it should be extended, since more limited nodal dissections are associated with high rates of false negative findings. In this context, quantifying the probability that a pathologically N0 patient has no potentially missing positive lymph nodes at PLND is key. We aimed at evaluating the probability that a pathologically node negative patient at PLND is a true pN0 according to the extent of nodal dissection. METHODS The study included 5353 patients submitted to radical prostatectomy and extended PLND between January 1987 and May 2012 at a single tertiary referral center. Extended PLND consisted of removal of obturator, external iliac, hypogastric ± presacral and common iliac lymph nodes. All patients had complete pathological data, including 2002 pathological T stage (namely, pT2, pT3a, pT3b/pT4), lymph node status, number of lymph nodes removed and of positive lymph nodes. The sensitivity of pathologic nodal staging using a beta-binomial model was estimated. A post-operative nodal staging score (pNSS) that represents the probability that a patient has been correctly staged as node negative as a function of the number of examined nodes was developed. Patients were stratified according to pathological stage. RESULTS Overall, 799 patients had LNI (14.9%). The mean number of nodes removed was 17 (median 16; IQR 11-21). When stratified according to pT stage, the mean and median number of lymph nodes removed was 16.1 and 15, 17.3 and 16, 18.3 and 17 in pT2, pT3a, pT3b/pT4 patients, respectively. Overall, the probability of missing a positive node decreases with the increasing number of lymph nodes removed and examined (48% if 5 nodes are examined, 29% if 10 are examined, 15% if 20 are examined, 8% if 30 are examined). The proportion of positive lymph nodes increased proportionally with advancing pathologic T stage (for 2.2, 15.3, 56.7% for pT2, pT3a, pT3b/pT4 disease; p<0.001). The probability of being truly N0 for a pathological node negative patient (pNSS) having 10 lymph nodes removed was 84, 89, 80% vs. 91,94, 88% in men with pT2, pT3a and pT3b/pT4 disease, respectively when 20 lymph nodes were removed. CONCLUSIONS We developed a model estimating the probability of false negative results in pN0 patients. In contrast to other tumors, a high number of lymph nodes removed (n=20) is required to reach high staging accuracy even in low disease stages. This should be taken into account when evaluating pathological reports of recurring patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e151 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Briganti Milan, Italy More articles by this author Alessandro Nonis Milan, Italy More articles by this author Chiara Brombin Milan, Italy More articles by this author Umberto Capitanio Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Alessandro Nini Milan, Italy More articles by this author Marco Bianchi Milan, Italy More articles by this author Massimo Freschi Milan, Italy More articles by this author Claudio Doglioni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Louis Kluth New York, NY More articles by this author Felix Chun Hamburg, Germany More articles by this author Shahrokh Shariat New York, NY More articles by this author Francesco Montorsi Milan, Italy More articles by this author Clelia Di Serio Milan, Italy More articles by this author Expand All Advertisement Advertisement Loading ...