title: First Nomogram Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients Undergoing Radioisotope Guided Sentinel Lymph Node Dissection.
abstract: BACKGROUND
  Existing nomograms predicting lymph node involvement (LNI) in prostate cancer (PCa) are based on conventional lymphadenectomy. The aim of the study was to develop the first nomogram for predicting LNI in PCa patients undergoing sentinel guided pelvic lymph node dissection (sPLND).
  
  
  METHODS
  Analysis was performed on 1,296 patients with PCa who underwent radioisotope guided sPLND and retropubic radical prostatectomy (2005-2010). Median prostate specific antigen (PSA): 7.4 ng/ml (IQR 5.3-11.5 ng/ml). Clinical T-categories: T1: 54.8%, T2: 42.4%, T3: 2.8%. Biopsy Gleason sums: ≤ 6: 55.1%, 7: 39.5%, ≥ 8: 5.4%. Multivariate logistic regression models tested the association between all of the above predictors and LNI. Regression-based coefficients were used to develop a nomogram for predicting LNI. Accuracy was quantified using the area under the curve (AUC).
  
  
  RESULTS
  The median number of LNs removed was 10 (IQR 7-13). Overall, 17.8% of patients (n = 231) had LNI. The nomogram had a high predictive accuracy (AUC of 82%). All the variables were statistically significant multivariate predictors of LNI (p = 0.001). Univariate predictive accuracy for PSA, Gleason sum and clinical stage was 69, 75 and 69%, respectively.
  
  
  CONCLUSIONS
  The sentinel nomogram can predict LNI at a sPLND very accurately and, for the first time, aid clinicians and patients in making important decisions on the indication of a sPLND. The high rate of LN+ patients underscores the sensitivity of sPLND.
authors.affiliation: Working Group Statistics and Econometrics, Georg-August University Gx00F6;ttingen, Gx00F6;ttingen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winter
authors.forename: Thomas
authors.initials: T
authors.lastname: Kneib
authors.forename: Martin
authors.initials: M
authors.lastname: Rohde
authors.forename: Rolf-Peter
authors.initials: RP
authors.lastname: Henke
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Wawroschek
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D010388:Pelvis; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D012007:Rectum; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013667:Technetium / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D013667:Technetium