title: Adherence to the lymphadenectomy recommendations of the 2009 clinical guidelines in the 2010 National Prostate Cancer Registry.
abstract: OBJECTIVE
  To assess the adherence to the recommendations of the 2009 clinical guidelines in the implementation of lymphadenectomy during radical prostatectomy and analysis of the variables that influence this decision in the 2010 National Prostate Cancer Registry.
  
  
  METHODS
  Analysis of 1,272 patients who underwent prostatectomy in 25 national hospitals. Patient classification according to the pathological node-positive (pN+) risk criteria included in the clinical guidelines of the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN). Calculation of the raw agreement and index of agreement kappa. Logistic regression to assess the predictors in the decision to perform lymphadenectomy.
  
  
  RESULTS
  Lymphadenectomy was performed on 225 (17.7%) patients, with a variability among centers of 0-62.2% (p<.001). There was lymphocytic invasion (pN+) in 17 (7.5%) patients. The raw agreement with the EAU-09 clinical guidelines was .672 (.48-.96 in the various centers), and the kappa index was .289. The raw agreement with the NCCN-09 clinical guidelines was.814 (.51-1 in the various centers), and the kappa index was .228. In the multivariate analysis, the independent predictors for performing lymphadenectomy were the Gleason score, the clinical stage, the prostate-specific antigen, the hospital center and the surgical approach route to prostatectomy (all P<.001).
  
  
  CONCLUSIONS
  In our study, adherence to the recommendations of the clinical guidelines on the implementation of lymphadenectomy was moderate. When deciding on lymphadenectomy, the determinants (in addition to the classic clinical variables) were the approach route and the hospital where the prostatectomy was performed.
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, España. Electronic address: felipeherranz@telefonica.net.
authors.forename: F
authors.initials: F
authors.lastname: Herranz Amo
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Hernández Fernández
authors.affiliation: Hospital Virgen de las Nieves, Granada, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Cózar Olmo
authors.affiliation: Hospital Morales Meseguer, Murcia, España.
authors.forename: B
authors.initials: B
authors.lastname: Miñana López
authors.affiliation: Complejo Hospitalario Universitario de A Coruña, La Coruña, España.
authors.forename: F
authors.initials: F
authors.lastname: Gómez-Veiga
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Antolín
authors.affiliation: Astellas Pharma, S.A., Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Pedrosa
mesh_terms: D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D013030:Spain
keywords: Adherence to clinical guidelines; Adherencia a guías clínicas; Cáncer de próstata; Factores predictores de linfadenectomía; Linfadenectomía; Lymphadenectomy; Predictors of lymphadenectomy; Prostate cancer; Prostatectomy; Prostatectomía