title: Yonsei nomogram to predict lymph node invasion in Asian men with prostate cancer during robotic era.
abstract: OBJECTIVE
  To develop a novel nomogram to predict lymph node invasion (LNI) in Asian men undergoing radical prostatectomy (RP) and pelvic LN dissection (PLND) for localised prostate cancer.
  
  
  METHODS
  The patient cohort included 541 patients who underwent robot-assisted RP and PLND by a single surgeon between January 2008 and December 2011. Patients with dissection of <10 LNs, prostate-specific antigen (PSA) levels of >50 ng/mL, incomplete biopsy data, and treatment with neoadjuvant therapy were excluded.
  
  
  RESULTS
  The median (interquartile range) number of LNs removed was 17 (14-22) and 45 patients (8.3%) had LN metastases. On multivariate logistic regression analysis, PSA level, clinical stage and Gleason score were independent predictors of LNI. The bootstrap corrected area under curve of the model incorporating PSA level, clinical stage, and biopsy Gleason score was 0.883. With a cutoff value of 4%, PLND could be omitted in 326 patients (60.2%), missing only two patients (4.4%) with LNI. The sensitivity, specificity, positive predictive value and negative predictive value were 95.6%, 65.3%, 20.0% and 99.4%, respectively.
  
  
  CONCLUSIONS
  We report a nomogram to predict LNI in Asian men with prostate cancer. The model demonstrated high accuracy and could be used for counselling patients and the selection of candidates for PLND.
authors.affiliation: Department of Urology, Yonsei University College of Medicine, Seoul, Korea; Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Sey Kiat
authors.initials: SK
authors.lastname: Lim
authors.forename: Ha Yan
authors.initials: HY
authors.lastname: Kim
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000368:Aged; D001208:Asia / Q000208:ethnology; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000208:ethnology / Q000473:pathology* / Q000601:surgery; D012371:Robotics / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D017430:Prostate-Specific Antigen
keywords: lymph node excision; nomograms; prostatectomy; prostatic neoplasm