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
Details Custom formula Study characteristics Files & References
Model author
Model ID
Revision date
MeSH terms
  • Lymphadenectomy
  • Cancer of the Prostate
  • Nomograms
  • Model type
    Logistic regression (Calculation)
    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
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL 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

    Related files

    Calculated risk for lymph node involvement is:

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    Calculated risk for lymph node involvement is:

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    Outcome stratification

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    Conditional information

    Result interpretation

    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. 

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

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