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WCE 2017: Analysis of Extended Lymph Node Dissection During Robot-Assisted Radical Prostatectomy: External Validation of Preoperative Nomograms

Vancouver, Canada (UroToday.com) The therapeutic and diagnostic benefit of a pelvic lymph node dissection (PLND) remains a highly debated topic in prostate cancer and radical prostatectomy – an issue further corroborated by the Will Rogers phenomenon. More recently, however, several preoperative nomograms have been developed to identify the subset of patients who may be the most likely to benefit. Despite the development and internal validation of each of these nomograms, there is no current consensus regarding which nomogram is the most predictive and should be applied to large-scale clinical practice. 

Dr. Kiyoshima of the Graduate School of Medical Sciences in Kyushu University presents an external validation of preoperative nomograms for extended pelvic lymph node dissection (ePLND) during robot-assisted radical prostatectomy (RARP). Between November 2011 and August 2016, 133 patients at his institution underwent ePLND during RARP. Median number of lymph node yield in all patients was approximately 19, with lymph node involvement (LNI) found in 20.3% of patients (27/133). Of these patients with LNI, there were a total of 51 positive nodes found and removed, with 23.9%, 16.7%, 60.0% in the obturator, external iliac, and internal iliac regions, respectively. This distribution parallels other series, particularly the open experience of other institutions in Japan. 

In ROC analysis, the Briganti nomogram had superior AUC in both sensitivity and specificity (0.699), as compared to the Japan PC Table (0.606) and the MSKCC nomogram (0.690). However, one comment made by the investigators is the low AUC for all nomograms, with the need for special attention to further target the Japanese patient population. In particular, the Japan PC Table appears to be inferior to both the Western nomograms and may require the development of a more updated nomogram for this particular subset of patients. 

Although the ideal candidate for pelvic lymph node dissections still needs to be defined, general agreement has been reached that if PLND is considered, PLND sampling should be extended to reach an adequate nodal staging accuracy. The predictive accuracy for nomograms predicting a therapeutic and/or diagnostic benefit are important metrics for future direction. 

Presented by: Dr. Keijiro Kiyoshima (PhD), 

Authors: Keijiro Kiyoshima, Junichi Inokuchi, Kenjiro Imada, Takashi Dejima, Eiji Kashiwagi,  Ario Takeuchi, Masaki Shiota, Katsunori Tatsugami, Masatoshi Eto
Affiliation: Emory University School of Medicine, Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan

Written by: Linda Huynh (BS), assistant research specialist, University of California, Irvine 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.