title: Pathologic nodal staging scores in patients treated with radical prostatectomy: a postoperative decision tool.
abstract: BACKGROUND
  Nodal metastasis is the strongest risk factor of disease recurrence in patients with localized prostate cancer (PCa) treated with radical prostatectomy (RP).
  
  
  OBJECTIVE
  To develop a model that allows quantification of the likelihood that a pathologically node-negative patient is indeed free of nodal metastasis.
  
  
  METHODS
  Data from patients treated with RP and pelvic lymph node dissection (PLND; n=7135) for PCa between 2000 and 2011 were analyzed. For external validation, we used data from patients (n=4209) who underwent an anatomically defined extended PLND.
  
  
  METHODS
  RP and PLND.
  
  
  METHODS
  We developed a novel pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative based on the number of examined nodes and the patient's characteristics.
  
  
  CONCLUSIONS
  In the development and validation cohorts, the probability of missing a positive node decreases with an increasing number of nodes examined. Whereas in pT2 patients, a 90% pNSS was achieved with one single examined node in both the development and validation cohort, a similar level of nodal staging accuracy was achieved in pT3a patients by examining five and nine nodes, respectively. The pT3b/T4 patients achieved a pNSS of 80% and 70% when 17 and 20 nodes in the development and validation cohort were examined, respectively. This study is limited by its retrospective design and multicenter nature. The number of nodes removed was not directly correlated with the extent/template of PLND.
  
  
  CONCLUSIONS
  Every patient needs PLND for accurate nodal staging. However, a one-size-fits-all approach is too inaccurate. We developed a tool that indicates a node-negative patient is indeed free of lymph node metastasis by evaluating the number of examined nodes, pT stage, RP Gleason score, surgical margins, and prostate-specific antigen. This tool may help in postoperative decision making.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Kluth
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital of Basel, Basel, Switzerland.
authors.forename: Malte
authors.initials: M
authors.lastname: Rieken
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Harun
authors.initials: H
authors.lastname: Fajkovic
authors.affiliation: Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Department of Urology, Krankenhaus der Barmherzigen Brueder, Vienna, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Schramek
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Herman
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Prostate Cancer Center, Martini Clinic, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.affiliation: Prostate Cancer Center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Loidl
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.affiliation: University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nonis
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.affiliation: Department of Urology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seiler
authors.affiliation: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Prostate Cancer Center, Martini Clinic, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tewari
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Division of Medical Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005188:False Negative Reactions; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D011184:Postoperative Period; D011336:Probability; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
keywords: Extended lymph node dissection; Lymph node metastasis; Nodal yield; Pelvic lymph node dissection; Prostate cancer