title: Pelvic lymph node dissection for prostate cancer: adherence and accuracy of the recent guidelines.
abstract: OBJECTIVE
  The 2004 National Comprehensive Cancer Network practice guidelines recommend pelvic lymph node dissection at radical prostatectomy. We sought to examine the adherence to the 2004 National Comprehensive Cancer Network guidelines and to test the their accuracy, as well as the accuracy of the most contemporary National Comprehensive Cancer Network, American Urological Association, and European Association of Urology guidelines to predict lymph node metastases.
  
  
  METHODS
  A total of 33 037 radical prostatectomy patients were identified, between 2004 and 2006. Adherence to the 2004 National Comprehensive Cancer Network guidelines was calculated using three clinically plausible cut-offs: 2, 5 and 10%. The accuracy was tested using the area under the curve.
  
  
  RESULTS
  Overall, 63% of patients underwent pelvic lymph node dissection. Of those, 61, 49 and 45% were managed according to the 2004 National Comprehensive Cancer Network guideline cut-off of 2, 5 and 10%, respectively. The accuracy of all the examined guidelines ranged from 61% to 71%. The highest accuracy was recorded for the European Association of Urology and the 2004 National Comprehensive Cancer Network cut-off 5% guidelines. The lowest accuracy was recorded for the most contemporary National Comprehensive Cancer Network guideline.
  
  
  CONCLUSIONS
  Adherence to the 2004 National Comprehensive Cancer Network guidelines was suboptimal. The accuracy of all the examined guidelines ranged from 61% to 71%. None of the examined guidelines can be regarded as an ideal indication for pelvic lymph node dissection.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Al'a
authors.initials: A
authors.lastname: Abdo
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017410:Practice Guidelines as Topic / Q000592:standards*; D011468:Prostatectomy / Q000592:standards* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D018426:SEER Program; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology