Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment.
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Kluth LA
1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
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Abdollah F
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
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Xylinas E
1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France.
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Rieken M
1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, University Hospital of Basel, Basel, Switzerland.
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Fajkovic H
Department of Urology, Medical University of Vienna, Vienna, Austria.
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Seitz C
Department of Urology, Medical University of Vienna, Vienna, Austria.
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Sun M
Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
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Karakiewicz PI
Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
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Schramek P
Department of Urology, Krankenhaus der Barmherzigen Brueder, Vienna, Austria.
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Herman MP
Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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Becker A
Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
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Hansen J
Prostate Cancer Center, Martini-Clinic, Hamburg, Germany.
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Ehdaie B
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Loidl W
Prostate Cancer Center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria.
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Pummer K
Department of Urology, Medical University of Graz, Graz, Austria.
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Lee RK
Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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Lotan Y
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Scherr DS
Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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Seiler D
Department of Urology, Kantonsspital Aarau, Aarau, Switzerland.
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Ahyai SA
Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
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Chun FK
Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
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Graefen M
Prostate Cancer Center, Martini-Clinic, Hamburg, Germany.
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Tewari A
Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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Nonis A
CUSSB (University Centre for Statistics in the Biomedical Sciences), Vita-Salute San Raffaele University, Milan, Italy.
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Bachmann A
Department of Urology, University Hospital of Basel, Basel, Switzerland.
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Montorsi F
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
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Gönen M
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Briganti A
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
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Shariat SF
1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, Medical University of Vienna, Vienna, Austria [3] Division of Medical Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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Published in:
- British journal of cancer. - 2014
English
BACKGROUND
Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status.
METHODS
We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes.
RESULTS
In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively.
CONCLUSIONS
Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.
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Language
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Open access status
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hybrid
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Persistent URL
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https://sonar.ch/global/documents/232335
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