Pelvic lymph node dissection for prostate cancer: Adherence and accuracy of the recent guidelines

Firas Abdollah, Al'a Abdo, Maxine Sun, Jan Schmitges, Zhe Tian, Alberto Briganti, Shahrokh F. Shariat, Paul Perrotte, Francesco Montorsi, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The 2004 National Comprehensive Cancer Network practice guidelines recommend pelvic lymph node dissection at radical prostatectomy. We sought to examine the adherence to the 2004 National Comprehensive Cancer Network guidelines and to test the their accuracy, as well as the accuracy of the most contemporary National Comprehensive Cancer Network, American Urological Association, and European Association of Urology guidelines to predict lymph node metastases. Methods: A total of 33037 radical prostatectomy patients were identified, between 2004 and 2006. Adherence to the 2004 National Comprehensive Cancer Network guidelines was calculated using three clinically plausible cut-offs: 2, 5 and 10%. The accuracy was tested using the area under the curve. Results: Overall, 63% of patients underwent pelvic lymph node dissection. Of those, 61, 49 and 45% were managed according to the 2004 National Comprehensive Cancer Network guideline cut-off of 2, 5 and 10%, respectively. The accuracy of all the examined guidelines ranged from 61% to 71%. The highest accuracy was recorded for the European Association of Urology and the 2004 National Comprehensive Cancer Network cut-off 5% guidelines. The lowest accuracy was recorded for the most contemporary National Comprehensive Cancer Network guideline. Conclusions: Adherence to the 2004 National Comprehensive Cancer Network guidelines was suboptimal. The accuracy of all the examined guidelines ranged from 61% to 71%. None of the examined guidelines can be regarded as an ideal indication for pelvic lymph node dissection.

Original languageEnglish
Pages (from-to)405-410
Number of pages6
JournalInternational Journal of Urology
Volume20
Issue number4
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Epidemiology and End Results program
  • Lymph node excision/statistics and numerical data
  • Lymphatic metastasis/diagnosis
  • Pelvis
  • Prostatic neoplasm/pathology
  • Surveillance

ASJC Scopus subject areas

  • Urology

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