OBJECTIVES: • To examine the ability of the threshold recommended by the National Comprehensive Cancer Network (NCCN) in correctly predicting histologically-confirmed lymph node invasion (LNI). • The 2010 NCCN practice guidelines for prostate cancer recommend a pelvic lymph node dissection (PLND) at radical prostatectomy in all individuals with a nomogram predicted LNI risk of ≥2%. PATIENTS AND METHODS: • We assessed 20 877 patients who were treated with radical prostatectomy and PLND between 2004 and 2006, within the Surveillance, Epidemiology and End Results database. • The 2% nomogram threshold, as well as other threshold values (range 1-10%) were tested. • Finally, we externally validated the NCCN guideline nomogram. RESULTS: • Overall, 2.5% of patients had LNI. • The use of the 2% threshold would allow the avoidance of 23% of PLNDs, at the cost of missing 1.7% of patients with LNI. Conversely, the use of a 3% threshold would allow the avoidance of 58% of PLNDs, at the cost of missing 15% of patients with LNI vs 72% and 26%, respectively, for the 4% threshold. • Overall, the accuracy of the NCCN guideline nomogram quantified according to the receiver-operator characteristics-derived area under the curve was 82%. CONCLUSIONS: • In a population-based sample, the NCCN guideline nomogram is highly accurate. • However, the 2% threshold will permit the avoidance of only 23% of PLNDs, instead of the 48% intended by the NCCN guidelines. • The use of a 3% threshold may allow a lower rate of PLND overtreatment, although it will miss more patients with LNI.
- Lymph node excision/statistics and numerical data
- Lymphatic metastasis/diagnosis
- Prostatic neoplasm/pathology
- SEER program
ASJC Scopus subject areas