A Nomogram for Staging of Exclusive Nonobturator Lymph Node Metastases in Men with Localized Prostate Cancer

Alberto Briganti, Felix K H Chun, Andrea Salonia, Giuseppe Zanni, Andrea Gallina, Federico Dehò, Nazareno Suardi, Luigi Filippo Da Pozzo, Luc Valiquette, Patrizio Rigatti, Francesco Montorsi, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Some patients with localized prostate cancer are at risk of nonobturator lymph node invasion (NOLNI) and may require an extended pelvic lymph node dissection (ePLND). We explored the rate of exclusive NOLNI and developed a nomogram to predict it. Material and methods: We mapped all ePLND specimens according to their anatomic location (obturator, external iliac, internal iliac lymph nodes) and assessed the location-specific rate of LNI in 565 patients. A multivariate logistic regression-based nomogram predicting NOLNI was then internally validated with 200 bootstrap resamples. Results: Overall, 11.1% (63 of 565) had LNI and 21 (3.7%) had exclusive NOLNI. The nomogram predicting exclusive NOLNI was 80.2% accurate. The nomogram's negative predictive value was 99%, when it predicted 0-10% probability of NOLNI. This approach could allow the omission of an ePLND in 350 of 565 (61.9%) patients and still correctly stage 85.8% of NOLNI cases. Conclusions: Our nomogram-based approach offers the possibility of identifying men who are at virtually zero risk of exclusive NOLNI. In these men, an ePLND may be safely avoided.

Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalEuropean Urology
Volume51
Issue number1
DOIs
Publication statusPublished - Jan 2007

Keywords

  • Lymph node invasion
  • Pelvic lymphadenectomy
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

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