Pathologic Nodal Staging Scores in Patients Treated with Radical Prostatectomy: A Postoperative Decision Tool

Kluth, Luis; Abdollah, Firas; Xylinas, Évanguelos; Rieken, Malte; Fajković, Harun; Sun, Maxine; Karakiewicz, Pierre I.; Seitz, Christian; Schramek, Paul; Herman, Michael; Becker, Andreas; Loidl, Wolfgang; Pummer, Karl; Nonis, Alessandro; Lee, Richard K.; Lotan, Yair; Scherr, Douglas S.; Seiler, Daniel; Chun, Felix K.-H.; Graefen, Markus; Tewari, Ashutosh; Gönen, Mithat; Montorsi, Francesco; Shariat, Shahrokh F.; Briganti, Alberto

doi:10.1016/j.eururo.2013.06.041

Cited by 27 publications

(47 citation statements)

References 31 publications

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“…Our model proves the concept that the needed extent of PLND is dependent on and can be predicted by the risk of LNI based on individual patient features, similar to a model we previously described for PCa (Kluth et al , 2013). Indeed, the one-size-fits-all approach is too inaccurate and one needs to estimate the individual risk of missing a positive LN.…”

Section: Discussionsupporting

confidence: 80%

Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment

et al. 2014

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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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Section: Discussionsupporting

confidence: 80%

Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment

et al. 2014

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“…As in a previously described methodology for colorectal, bladder, and PCa (Gonen et al, 2009;Kluth et al, 2013), we tested the probability of incorrect nodal staging as a function of the number of examined LNs. The true LN status is practically unascertainable as there is no way to ascertain the false-negative rate.…”

Section: Methodsmentioning

confidence: 99%

723 Clinical nodal staging scores for prostate cancer: A proposal for preoperative risk assessment

Kluth¹,

Abdollah²,

Xylinas³

et al. 2014

European Urology Supplements

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“…Recently, Kluth et al 33 34 developed predictive models to assess the minimum number of LNs required for accurate staging in an individual patient based on tumour characteristics in the preoperative or postoperative setting. The authors propose that patients at a higher risk of LN metastases require examination of a larger number of LNs to accurately predict LN-negative status and this can be used to tailor the extent of PLND.…”

Section: Ln Yield At Plndmentioning

confidence: 99%

“…The authors propose that patients at a higher risk of LN metastases require examination of a larger number of LNs to accurately predict LN-negative status and this can be used to tailor the extent of PLND. For preoperative risk assessment, they developed their model on a cohort of 4770 patients whose PLND extent was at the discretion of the surgeon and subsequently validated it on 3595 patients who underwent an extended PLND 33. Using their model, high-risk patients in the validation cohort required examination of at least 10 LNs to achieve 80% probability of being truly LN-negative 31…”

Section: Ln Yield At Plndmentioning

confidence: 99%

Lymph node staging in prostate cancer: perspective for the pathologist

Prendeville

Kwast

2016

J Clin Pathol

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Pelvic lymph node dissection (PLND) currently represents the gold standard method for nodal staging in the setting of localised prostate cancer and may also have a therapeutic benefit in certain patients. The histopathological evaluation of PLND specimens plays a critical role in accurate lymph node staging, however there is currently a lack of consensus regarding the optimum approach and no quality parameters are in place. In addition, there are no guidelines as to the handling of less commonly encountered nodal specimens such as those identified within the anterior fat pad. This summary provides an overview of pertinent issues regarding lymph node staging in prostate cancer, with a focus on the histopathological evaluation of resected nodal specimens. We hope that this review will further the discussion on how to achieve a more standardised approach to the processing and reporting of PLND specimens in the setting of prostate cancer.

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Pathologic Nodal Staging Scores in Patients Treated with Radical Prostatectomy: A Postoperative Decision Tool

Cited by 27 publications

References 31 publications

Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment

Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment

723 Clinical nodal staging scores for prostate cancer: A proposal for preoperative risk assessment

Lymph node staging in prostate cancer: perspective for the pathologist

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