First Nomogram Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients Undergoing Radioisotope Guided Sentinel Lymph Node Dissection.

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).

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)

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

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 © 2015 S Karger AG, Basel

Urologia internationalis 2015 Jul 03 [Epub ahead of print]

Alexander Winter, Thomas Kneib, Martin Rohde, Rolf-Peter Henke, Friedhelm Wawroschek

Working Group Statistics and Econometrics, Georg-August University Göttingen, Göttingen, Germany