title: Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment.
abstract: 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.
authors.affiliation: 1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
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authors.initials: LA
authors.lastname: Kluth
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: 1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: 1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, University Hospital of Basel, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Rieken
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: H
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authors.lastname: Fajkovic
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
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authors.affiliation: Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
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authors.affiliation: Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
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authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Department of Urology, Krankenhaus der Barmherzigen Brueder, Vienna, Austria.
authors.forename: P
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: M P
authors.initials: MP
authors.lastname: Herman
authors.affiliation: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.affiliation: Prostate Cancer Center, Martini-Clinic, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hansen
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: B
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: Prostate Cancer Center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Loidl
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: K
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authors.lastname: Pummer
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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authors.initials: RK
authors.lastname: Lee
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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authors.initials: Y
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authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Scherr
authors.affiliation: Department of Urology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Seiler
authors.affiliation: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: S A
authors.initials: SA
authors.lastname: Ahyai
authors.affiliation: Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: F K-H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Prostate Cancer Center, Martini-Clinic, Hamburg, Germany.
authors.forename: M
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: A
authors.initials: A
authors.lastname: Tewari
authors.affiliation: CUSSB (University Centre for Statistics in the Biomedical Sciences), Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nonis
authors.affiliation: Department of Urology, University Hospital of Basel, Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Bachmann
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gönen
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Briganti
authors.affiliation: 1] Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA [2] Department of Urology, Medical University of Vienna, Vienna, Austria [3] Division of Medical Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
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mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment