title: A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer.
abstract: OBJECTIVE
  We developed a preoperative nomogram for prediction of lymph node metastases in patients with clinically localized prostate cancer.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (p <0.001). 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Makato
authors.initials: M
authors.lastname: Ohori
authors.forename: Farhang
authors.initials: F
authors.lastname: Rabbani
authors.forename: Claudia
authors.initials: C
authors.lastname: Gerigk
authors.forename: Victor
authors.initials: V
authors.lastname: Reuter
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Peter G
authors.initials: PG
authors.lastname: Hammerer
authors.forename: Andreas
authors.initials: A
authors.lastname: Erbersdobler
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Patrick
authors.initials: P
authors.lastname: Kupelian
authors.forename: Eric
authors.initials: E
authors.lastname: Klein
authors.forename: David I
authors.initials: DI
authors.lastname: Quinn
authors.forename: Susan M
authors.initials: SM
authors.lastname: Henshall
authors.forename: John J
authors.initials: JJ
authors.lastname: Grygiel
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sutherland
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Stricker
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morash
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016879:Salvage Therapy
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen