Winter nomogram: Predicting lymph node involvement through sentinel guided

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Winter nomogram: Predicting lymph node involvement through sentinel guided pelvic lymph node dissection (SPLND)

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).

Research authors: Alexander Winter, T. Kneib, M. Rohde, R.P. Henke, F. Wawroschek

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★★

Model author

T. A. Hueting

Model ID

681

Version

1.14

Revision date

2018-04-24

Specialty

Oncology, Urology

MeSH terms

Lymphadenectomy

Cancer of the Prostate

Nomograms

Model type

Logistic regression ^{(Calculation)}

Status

public

Rating

★ ★

Formula
No Formula defined yet

Condition	Formula

Additional information

A total of 1,325 consecutive patients with prostate carcinoma were identified, who underwent sPLNDs in combination with Radical Retropubic Prostatectomy carried out by 4 highly experienced surgeons, in a single center between January 2005 and April 2010. We excluded patients with incomplete clinical information for prostate specific antigen (PSA), clinical stage or biopsy Gleason score (n = 4, 0.3%). Furthermore, we also excluded patients who had undergone a transurethral resection or laser therapy of the prostate (n = 14, 1.1%) and cT4 tumors (n = 8, 0.6%). An additional 3 patients (0.2%) were also excluded, since no SLN could be detected by the gamma probe. The final sample comprised 1,296 patients.

Study Population

Total population size: 1296

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Females: {{ model.numberOfFemales }}

Continuous characteristics

Name	Q1	Median	Q3	Unit
Age	61	66	70	Years
Total PSA	5.3	7.4	11.5	ng/ml
Lymph nodes removed	7	10	13	No. of lymph nodes

Categorical characteristics

Name	Subset / Group	Nr. of patients
T-category	T1c	710
	T2a	171
	T2b	160
	T2c	219
	T3	36
Biopsy Gleason Sum	≤6	714
	7	512
	≥8	70
Postoperative Gleason sum	≤6	269
	7	942
	≥8	73
Pathologic stage	pT2	841
	pT3a	231
	pT3b	182
	pT4	42

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According to the internal validation, a 7% threshold would be regarded as the most favorable cutoff. In our population of 1,296 patients, 406 patients (31.3%) were classified below this threshold. Avoidance of sPLND in those 406 cases would have resulted in missing LNI in 7 patients or in 3% of all patients with histologically confirmed LNI. Therefore, approximately one-third of patients could be spared from sPLND. Considerable costs and patient discomfort could be saved.

Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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Study Population

Continuous characteristics

Categorical characteristics

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Categorical characteristics

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Supporting Publications

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Calculated risk for lymph node involvement is:

Outcome stratification

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