A Preoperative Nomogram Identifying Decreased Risk of Positive Pelvic Lymph Nodes in Patients With Prostate Cancer
| Autor: | Susan Henshall, Makato Ohori, Patrick A. Kupelian, Peter T. Scardino, David I. Quinn, Pierre I. Karakiewicz, Markus Graefen, Claudia Gerigk, Christopher Morash, Eric A. Klein, Michael W. Kattan, Andreas Erbersdobler, Farhang Rabbani, Peter G. Hammerer, Ilias Cagiannos, Robert L. Sutherland, Hartwig Huland, Victor E. Reuter, Phillip D. Stricker, John J. Grygiel, James A. Eastham |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology medicine.medical_treatment urologic and male genital diseases Metastasis Prostate cancer Predictive Value of Tests Prostate Biomarkers Tumor Humans Medicine Lymph node Neoadjuvant therapy Aged Neoplasm Staging Probability Aged 80 and over Prostatectomy Salvage Therapy business.industry Prostatic Neoplasms Middle Aged Prostate-Specific Antigen Nomogram medicine.disease Neoadjuvant Therapy Surgery Prostate-specific antigen Logistic Models medicine.anatomical_structure Lymphatic Metastasis Lymph Node Excision Lymph Nodes business |
| Zdroj: | Journal of Urology. 170:1798-1803 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1097/01.ju.0000091805.98960.13 |
| Popis: | We developed a preoperative nomogram for prediction of lymph node metastases in patients with clinically localized prostate cancer.The study was a retrospective, nonrandomized analysis of 7,014 patients treated with radical prostatectomy at 6 institutions between 1985 and 2000. Exclusion criteria consisted of preoperative androgen ablation therapy, salvage radical prostatectomy and pretreatment prostate specific antigen (PSA) greater than 50 ng/ml. Preoperative predictors of lymph node metastases consisted of pretreatment PSA, clinical stage (1992 TNM) and biopsy Gleason sum. These predictors were used in logistic regression analysis based nomograms to predict the probability of lymph node metastases.Overall 5,510 patients with complete clinical and pathological information were included in the study. Lymph nodes metastases were present in 206 patients (3.7%). Pretreatment PSA, biopsy Gleason sum, clinical stage and institution represented predictors of lymph node status (p0.001). Bootstrap corrected predictive accuracy of the 3-variable nomogram (clinical stage, Gleason sum and PSA) was 0.76. Inclusion of a fourth variable, which accounts for institutional differences in lymph node metastases, yielded an area under the receiver operating characteristics curve of 0.78. The negative predictive value of our nomograms was 0.99 when they predicted 3% or less chance of positive lymph nodes.Using clinical information, we produced 2 calibrated and validated nomograms, which accurately predict pathologically negative lymph nodes in men with localized prostate cancer who are candidates for radical prostatectomy. |
| Databáze: | OpenAIRE |
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