MP63-20 DEVELOPMENT AND EXTERNAL VALIDATION OF A PATHOLOGICAL NODAL STAGING SCORE FOR PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA (2015)

You have accessJournal of UrologyKidney Cancer: Surgical Therapy IV1 Apr 2015MP63-20 DEVELOPMENT AND EXTERNAL VALIDATION OF A PATHOLOGICAL NODAL STAGING SCORE FOR PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA Malte Rieken, Stephen Boorjian, Luis Kluth, Evanguelos Xylinas, Umberto Capitanio, Alberto Briganti, R. Houston Thompson, Bradley Leibovich, Laura-Maria Krabbe, Vitaly Margulis, Jay Raman, Mikhail Regelman, Tobias Klatte, Alexander Bachmann, Pierre Karakiewicz, Morgan Rouprêt, Richard Lee, Mithat Gönen, and Shahrokh Shariat Malte RiekenMalte Rieken More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Luis KluthLuis Kluth More articles by this author , Evanguelos XylinasEvanguelos Xylinas More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Jay RamanJay Raman More articles by this author , Mikhail RegelmanMikhail Regelman More articles by this author , Tobias KlatteTobias Klatte More articles by this author , Alexander BachmannAlexander Bachmann More articles by this author , Pierre KarakiewiczPierre Karakiewicz More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , Richard LeeRichard Lee More articles by this author , Mithat GönenMithat Gönen More articles by this author , and Shahrokh ShariatShahrokh Shariat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2352AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymph node metastasis (LNM) is a strong predictor of adverse outcomes in patients with clear cell renal cell carcinoma (ccRCC). We aimed to develop and externally validate a model that quantifies the likelihood that a pathologically node-negative patient has, indeed, no LNM. METHODS Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. 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). For external validation, we used data from 2279 patients in the Surveillance, Epidemiology and End Results (SEER) database. 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. LNM was detected in 14.3% (n=198) of the patients in the development cohort compared to 10.0% (n=227) in the validation cohort (p<0.001). The probability of missing a positive LN decreased with increasing number of LNs examined. When compared to the probabilities of missing a LN in the development cohort, fewer LNs were needed in the validation cohort to reach the same level of probability; however these differences were not statistically significant (all p-values>0.05). 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. Significant differences in the probabilities between the development and validation cohorts were detected in patients Fuhrman grade III/IV tumors (p<0.001) (Image). CONCLUSIONS The number of examined LNs needed for adequate nodal staging in ccRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patients counseling, decision-making regarding risk stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193 Issue 4S April 2015 Page: e797 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Malte Rieken More articles by this author Stephen Boorjian More articles by this author Luis Kluth More articles by this author Evanguelos Xylinas More articles by this author Umberto Capitanio More articles by this author Alberto Briganti More articles by this author R. Houston Thompson More articles by this author Bradley Leibovich More articles by this author Laura-Maria Krabbe More articles by this author Vitaly Margulis More articles by this author Jay Raman More articles by this author Mikhail Regelman More articles by this author Tobias Klatte More articles by this author Alexander Bachmann More articles by this author Pierre Karakiewicz More articles by this author Morgan Rouprêt More articles by this author Richard Lee More articles by this author Mithat Gönen More articles by this author Shahrokh Shariat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...