Percentage of positive biopsy cores can improve the ability to predict lymph node invasion in patients undergoing radical prostatectomy and extended pelvic lymph node dissection

被引:76
作者
Briganti, Alberto
Karakiewicz, Pierre I.
Chun, Felix K. -H.
Gallina, Andrea
Salonia, Andrea
Zanni, Giuseppe
Valiquette, Luc
Graefen, Markus
Huland, Hartwig
Rigatti, Patrizio
Montorsi, Francesco
机构
[1] Univ Montreal, Ctr Hlth, Canc Prognost & Hlth Outcomes Unit, Montreal, PQ H2X 3J4, Canada
[2] Vita Salute Univ, Dept Urol, Milan, Italy
[3] Univ Hamburg, Dept Urol, Hamburg, Germany
关键词
prostate cancer; lymph node invasion; pelvic lymphadenectomy; nomogram;
D O I
10.1016/j.eururo.2007.01.108
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objective: We hypothesized that the information stemming from biopsy cores can enhance the ability to predict the rate of lymph node invasion (LNI) at radical retropubic prostatectomy (RRP) in men subjected to extended pelvic lymphadenectomy (ePLND). Materials and methods: A cohort of 278 consecutive patients (mean age: 66.2 yr) underwent a RRP and an ePLND, in which 10 or more nodes were removed and examined. The median PSA was 7.5 ng/ml. Clinical stage was mostly T1c (59.4%) and T2 (37.8%). Biopsy Gleason sum was 2-5 in 26.6%,6 in 39.2%, 7 in 27%, and 8-10 in 7.2%. The number of positive cores was 1-19 (median: 4), whilst percentage of positive cores was 7.1-100% (median: 37.5%). Logistic regression models tested the association between the above predictors and LNI. Testing of PSA was coded as either a continuous variable (CV) or a cubic spline (CS). Individual variables and combined accuracy were tested in regression-based nomograms, which were subjected to 10,000 bootstrap resamples to reduce overfit bias. Results: Mean number of lymph nodes examined was 17.5 (range: 10-38); 29 patients (10.4%) had LNI. Percentage of positive cores (78.5%) and biopsy Gleason sum (78.4%) were the most informative predictors of LNI. A nomogram based on clinical stage, PSA (CV), and biopsy Gleason sum was 79.7% accurate versus 83% (3.3% gain, p < 0.001) when percentage of positive cores was added. A 2.7% gain (83.7% vs. 81%; p < 0.001) was recorded after the addition of the percentage of positive cores when PSA was coded as a CS. Conclusions: Percentage of positive biopsy cores should be considered in prediction of LNI at ePLND, because it significantly improves the combined accuracy of established clinical predictors such as PSA, clinical stage, and biopsy Gleason sum. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:1573 / 1581
页数:9
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