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Wang H, Yang Y, zhu K, Zhu N, Gong L, Zhang H, Ma M, Ren P, Qiao Y, Liu X, Tang P, Yu Z. Development and validation of nodal staging score in pN0 patients with esophageal squamous cell carcinoma: A population study from the SEER database and a single-institution cohort. Thorac Cancer 2022; 13:3257-3267. [PMID: 36221304 PMCID: PMC9715890 DOI: 10.1111/1759-7714.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with esophageal squamous cell carcinoma (ESCC) with lymph node metastasis may be misclassified as pN0 due to an insufficient number of lymph nodes examined (LNE). The purpose of this study was to confirm that patients with ESCC are indeed pN0 and to propose an adequate number for the correct nodal stage using the nodal staging score (NSS) developed by the beta-binomial model. METHODS A total of 1249 patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2017, and 1404 patients diagnosed with ESCC in our database between 2005 and 2018 were included. The NSS was developed to assess the probability of pN0 status based on both databases. The effectiveness of NSS was verified using survival analysis, including Kaplan-Meier curves and Cox models. RESULTS Many patients were misclassified as pN0 based on our algorithm due to insufficient LNE. As the number of LNE increased, false-negative findings dropped; accordingly, the NSS increased. In addition, NSS was an independent prognostic indicator for pN0 in patients with ESCC in the SEER database (hazard ratio [HR] 0.182, 95% confidence interval [CI] 0.046-0.730, p = 0.016) and our database (HR 0.215, 95% CI 0.055-0.842, p = 0.027). A certain number of nodes must be examined to achieve 90% of the NSS. CONCLUSIONS NSS could determine the probability of true pN0 status for patients, and it was sufficient in predicting survival and obtaining adequate numbers for lymphadenectomy.
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Affiliation(s)
- Haitong Wang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Yueyang Yang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Kai zhu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Ningning Zhu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Hongdian Zhang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Mingquan Ma
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Peng Ren
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Yufeng Qiao
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Xiangming Liu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Peng Tang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenChina
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Paulsen F, Bedke J, Wegener D, Marzec J, Martus P, Nann D, Stenzl A, Zips D, Müller AC. On the probability of lymph node negativity in pN0-staged prostate cancer-a theoretically derived rule of thumb for adjuvant needs. Strahlenther Onkol 2021; 198:690-699. [PMID: 34476527 PMCID: PMC9300491 DOI: 10.1007/s00066-021-01841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Purpose The extent of lymphadenectomy and clinical features influence the risk of occult nodes in node-negative prostate cancer. We derived a simple estimation model for the negative predictive value (npv) of histopathologically node-negative prostate cancer patients (pN0) to guide adjuvant treatment. Methods Approximations of sensitivities in detecting lymph node metastasis from current publications depending on the number of removed lymph nodes were used for a theoretical deduction of a simplified formulation of npv assuming a false node positivity of 0. Results A theoretical formula of npv = p(N0IpN0) = (100 − prevalence) / (100 − sensitivity × prevalence) was calculated (sensitivity and preoperative prevalence in %). Depending on the number of removed lymph nodes (nLN), the sensitivity of pN0-staged prostate cancer was derived for three sensitivity levels accordingly: sensitivity = f(nLN) = 9 × nLN /100 for 0 ≤ nLN ≤ 8 and f(nLN) = (nLN + 70) /100 for 9 ≤ nLN ≤ 29 and f(nLN) = 1 for nLN ≥ 30. Conclusion We developed a theoretical formula for estimation of the npv in pN0-staged prostate cancer patients. It is a sine qua non to use the formula in a clinically experienced context before deciding to electively irradiate pelvic lymph nodes or to intensify adjuvant systemic treatment.
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Affiliation(s)
- Frank Paulsen
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Jens Bedke
- Department of Urology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jolanta Marzec
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Silcherstraße 5, 72076, Tübingen, Germany
| | - Dominik Nann
- Institute of Pathology, Eberhard Karls University, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Arndt-Christian Müller
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Huang XT, Huang CS, Li JH, Chen W, Gan TT, Wang XY, Liang LJ, Yin XY. Evaluating the adequacy of nodal status in node-negative gallbladder cancer with T1b-T2 stages: use of nodal staging score. HPB (Oxford) 2021; 23:795-801. [PMID: 33051141 DOI: 10.1016/j.hpb.2020.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The study aimed at establishing a nodal staging score (NSS) to quantify the likelihood that pathologic node-negative gallbladder cancer (GBC) patients are indeed free of lymph node (LN) metastasis. METHODS Clinicopathological data of 1374 GBC patients with T1b-T2 stages were collected from the Surveillance, Epidemiology and End Result database (design cohort [DC], n = 1289) and the First Affiliated Hospital of Sun Yat-sen University (validation cohort [VC], n = 85). NSS was derived from the count of examined LNs (ELNs) and T stage by using a beta-binomial model, and represented the probability that a node-negative patient is correctly staged. The prognostic value of NSS in node-negative GBC was evaluated by survival analysis. RESULTS The probability of missing a nodal disease in node-negative GBC patients with T1b-T2 stages (pT1bN0 and pT2N0) decreased as the number of ELNs increased. NSS increased as the number of ELNs increased. For pT1bN0 and pT2N0 patients, examination of 5 and 27 lymph nodes could ensure an NSS of 90.0%, respectively. Multivariate analysis revealed that NSS was an independent predictor for overall survival in pT1bN0 and pT2N0 GBC patients (DC, HR:0.53, 95%CI: 0.42-0.66, p < 0.001; VC, HR: 0.33, 95%CI: 0.14-0.76, p = 0.009). CONCLUSION NSS could evaluate the adequacy of nodal staging and predict the prognosis in pT1bN0 and pT2N0 GBC patients, and hence was helpful to guide their treatment strategies.
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Affiliation(s)
- Xi-Tai Huang
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Chen-Song Huang
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Jian-Hui Li
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Wei Chen
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Tian-Tian Gan
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Xi-Yu Wang
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Li-Jian Liang
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China
| | - Xiao-Yu Yin
- The Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, PR China.
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Use of Nodal Staging Score in Evaluating the Accuracy of Pathologic Nodal Status in Node-Negative Ampullary Carcinoma. J Gastrointest Surg 2021; 25:1001-1009. [PMID: 32253644 DOI: 10.1007/s11605-020-04572-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The minimum number of lymph nodes (LNs) that should be resected for accurate nodal staging in patients with ampullary carcinoma (AC) remains controversial. This study aimed to establish a nodal staging score (NSS) to evaluate whether a pathological node-negative AC patient is indeed free of a nodal disease. METHODS A total of 2539 AC patients with stages I-III were retrieved from the Surveillance, Epidemiology and End Result database (design cohort [DC], n = 2382) and First Affiliated Hospital of Sun Yat-sen University (validation cohort [VC], n = 157). NSS was developed to represent the probability that a node-negative patient was correctly staged as a function of the number of examined LNs (ELNs) and pathologic T stage with a beta-binomial model. Its prognostic value in node-negative patients was assessed by survival analysis. RESULTS The probability of missing a metastatic LN decreased as the number of the ELNs increased. NSS was escalated as the number of ELNs increased. For patients with early-stage (T1-T2) and late-stage (T3-T4) tumors, examining 7 and 33 lymph nodes could ensure an NSS of 80.0%, respectively. Multivariate analysis showed that higher NSS was an independent favorable prognostic factor for overall survival in node-negative patients with AC (DC, p < 0.001; VC, p = 0.001). CONCLUSIONS NSS model could be used to evaluate the accuracy of nodal staging and predict the prognosis of node-negative AC patients. It could assist in making clinical strategies in node-negative AC patients.
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Abstract
The lymph nodal invasion diagnosis is critical for therapeutic-decision and follows up in gastric cancer. However, the number of nodes to be examined for nodal invasion diagnosis is still under controversy, and the model for quantifying risk of missing positive node is currently not reported yet. We analyzed the nodal invasion status of 13,857 gastric cancer samples with records of primary tumor stage, the number of examined and positive lymph nodes in the surveillance, epidemiology, and end results (SEER) database, fitting a beta-binomial model. The nodes need to be examined with different primary tumor stage were determined based on the model. Overall, examining 11 lymph nodes reduces the probability of missing positive nodes to <10%, and the currently median nodes dissected is adequate (12 nodes). While the number of nodes demands to be dissected for T1, T2, T3, and T4 subgroups are 6, 19, 40, and 66, respectively. The currently implemented median value for these samples was 12, 12, 13, and 16, separately. It implies that the number of nodes to be examined is sufficient for early gastric cancer (T1), but it is inadequate for middle and advanced gastric cancer (T2-T3). The clinical significance of nodal staging score was validated with survival information. In summary, we first quantified the lymph nodes to be examined during surgery using a beta-binomial model, and validated with survival information.
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Affiliation(s)
- Liping Sun
- Shanghai University of Medicine & Health Sciences, Shanghai
| | - Qiaohong Liu
- Shanghai University of Medicine & Health Sciences, Shanghai
| | - He Ren
- Shanghai University of Medicine & Health Sciences, Shanghai
| | - Ping Li
- Shanghai University of Medicine & Health Sciences, Shanghai
| | - Gang Liu
- Shanghai University of Medicine & Health Sciences, Shanghai
| | - Lining Sun
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, P.R. China
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Sun L, Li P, Ren H, Liu G, Sun L. Quantifying the number of lymph nodes for examination in breast cancer. J Int Med Res 2019; 48:300060519879594. [PMID: 31640445 PMCID: PMC7607195 DOI: 10.1177/0300060519879594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Examining the correct number of lymph nodes when diagnosing breast cancer invasion is still a problem. This work aimed to develop a qualification model that estimates the possibility of missing nodes and the number of lymph nodes that need to be examined. METHODS By analyzing lymph node invasion of 303,760 breast cancer samples with primary tumor stage and the number of examined and positive lymph nodes from the Surveillance, Epidemiology and End Results database using a beta-binomial model, the number of nodes that should be examined was quantified in different stages. RESULTS In general, to reduce the possibility of missing positive nodes to less than 10%, 21 lymph nodes should be examined; thus, the current median of dissected nodes (12) is not adequate. The number of nodes needed to be dissected for stages T1, T2, and T3 are 8, 37, and 87, respectively. Currently, the median number of node dissections for these stages were 12, 13, and 14, respectively. The clinical significance of the nodal staging score was validated with survival information. CONCLUSION Currently, the number of lymph nodes dissected in breast cancer are excessive for T1 but insufficient for T2 and T3.
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Affiliation(s)
- Liping Sun
- Shanghai University of Medicine & Health Sciences, Shanghai, P.R. China
| | - Ping Li
- Shanghai University of Medicine & Health Sciences, Shanghai, P.R. China
| | - He Ren
- Shanghai University of Medicine & Health Sciences, Shanghai, P.R. China
| | - Gang Liu
- Shanghai University of Medicine & Health Sciences, Shanghai, P.R. China
| | - Lining Sun
- School of Mechanical and Electric Engineering, Soochow University, Suzhou, China
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7
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Rieken M, Boorjian SA, Kluth LA, Capitanio U, Briganti A, Thompson RH, Leibovich BC, Krabbe LM, Margulis V, Raman JD, Regelman M, Karakiewicz PI, Rouprêt M, Abufaraj M, Foerster B, Gönen M, Shariat SF. Development and external validation of a pathological nodal staging score for patients with clear cell renal cell carcinoma. World J Urol 2019; 37:1631-1637. [PMID: 30406477 PMCID: PMC8389144 DOI: 10.1007/s00345-018-2555-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/30/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To develop and externally validate a model that quantifies the likelihood that a pathologically node-negative patient with clear cell renal cell carcinoma (cRCC) has, indeed, no lymph node metastasis (LNM). PATIENTS AND METHODS Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. For external validation, we used data from 2270 patients in the Surveillance, Epidemiology and End Results (SEER) database. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node negative as a function of the number of examined lymph nodes (LNs). RESULTS The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD 6.6; interquartile range, IQR 7.0) in the development cohort and 5.6 and 2.0 (SD 8.6, IQR 5.0) in the validation cohort, respectively. The probability of missing a positive LN decreased with increasing number of LNs examined. In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman grade. CONCLUSIONS The number of examined LNs needed for adequate nodal staging in cRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patient counseling, decision-making regarding risk-stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.
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Affiliation(s)
- Malte Rieken
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
- University of Basel, Basel, Switzerland
| | - Stephen A Boorjian
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA
| | - Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Umberto Capitanio
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - R Houston Thompson
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA
| | - Bradley C Leibovich
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mikhail Regelman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Morgan Rouprêt
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
- Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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Bersanelli M, Buti S, Santoni M, Ziglioli F, Maestroni U. Pathological nodal staging score for renal cell carcinoma: how to build reliable therapeutic choices basing on assumptions. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S54. [PMID: 31032333 DOI: 10.21037/atm.2019.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Hospital of Macerata, Macerata, Italy
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Abstract
Aims The number of lymph nodes (LNs) excised in patients with pathologic N0 is limited, and it is very likely that there will be recessive node disease after surgery, so they are at risk of understaging. The purpose of the present study is to develop a nodal staging score (NSS) in a mathematical way to assess the likelihood that a pathologic N0 gastric cancer (GCa) patient has, indeed, no occult nodal disease after surgery. Patients and methods A total of 14,033 stage I-III GCa patients were identified from Surveillance, Epidemiology and End Results database for analysis. A beta-binomial model was fitted to calculate the probability of missing a nodal disease. This probability is then used to calculate the NSS. Results The probability of missing a nodal disease is decreased with increasing LNs examined across all pT stages. Seven and 24 LNs removed and examined was enough for an NSS of 90% in pT1 and pT2 patients, respectively, ensuring a high confidence of correct nodal negative classification. Twenty-three and 31 LNs examined in pT3 and pT4 patients could also maintain the NSS at 80%, respectively. NSS had a significant impact on patients' survival across all pT stages (all Ps <0.0001). Conclusion The probability that GCa patients are free of true nodal disease could be provided by NSS-based prediction, which is conducive to postoperative decision and survival surveillance. In addition, NSS can define a subtle standard on how many LNs examined are enough for adequate staging dependent on pT stages. However, at least 16 LNs examined is the standard recommendation to date.
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Affiliation(s)
- Hui-Min Chen
- Nanjing Jiangbei People's Hospital, Nanjing 220000, People's Republic of China,
| | - Ge Feng
- Nanjing Jiangbei People's Hospital, Nanjing 220000, People's Republic of China,
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Dai W, Li Y, Wu Z, Feng Y, Cai S, Xu Y, Li Q, Cai G. Pathological nodal staging score for rectal cancer patients treated with radical surgery with or without neoadjuvant therapy: a postoperative decision tool. Cancer Manag Res 2019; 11:537-546. [PMID: 30662284 PMCID: PMC6327887 DOI: 10.2147/cmar.s169309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Lymph node status can predict the prognosis of patients with rectal cancer treated with surgery. Thus, we sought to establish a standard for the minimum number of lymph nodes (LNs) examined in patients with rectal cancer by evaluating the probability that pathologically negative LNs prove positive during surgery. Patients and methods We extracted information of 31,853 patients with stage I–III rectal carcinoma registered between 2004 and 2013 from the Surveillance, Epidemiology, and End Results database and divided them into two groups: the first group was SURG, including patients receiving surgery directly and the other group was NEO, encompassing those underwent neo-adjuvant therapy. Using a beta-binomial model, we developed nodal staging score (NSS) based on pT/ypT stage and the number of LNs retrieved. Results In both cohorts, the false-negative rate was estimated to be 16% when 12 LNs were examined, but it dropped to 10% when 20 LNs were evaluated. In the SURG cohort, to rule out 90% possibility of false staging, 3, 7, 28, and 32 LNs would be necessarily examined in patients with pT1–4 disease, respectively. While in the NEO cohort, 4, 7, 12, and 16 LNs would be included for examination in patients with ypT1–4 disease to guarantee an NSS of 90%. Conclusion By determining whether a rectal cancer patient with negative LNs was appropriately staged, the NSS model we developed in this study may assist in tailoring postoperative management.
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Affiliation(s)
- Weixing Dai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
| | - Yaqi Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yang Feng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, ,
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Hua J, Zhang B, Xu J, Liu J, Ni Q, He J, Zheng L, Yu X, Shi S. Determining the optimal number of examined lymph nodes for accurate staging of pancreatic cancer: An analysis using the nodal staging score model. Eur J Surg Oncol 2019; 45:1069-1076. [PMID: 30685327 DOI: 10.1016/j.ejso.2019.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the optimal number of examined lymph nodes (ELNs) for accurate staging of pancreatic cancer using the nodal staging score model. MATERIALS AND METHODS Clinicopathological data for patients with resected pancreatic cancer were collected from SEER database (development cohort [DC]) and Fudan University Shanghai Cancer Center database (validation cohort [VC]). Multivariable models were constructed to assess how the number of ELNs was associated with stage migration and overall survival (OS). Using the β-binomial distribution, we developed a nodal staging score model from the DC and tested it with the VC. RESULTS Both cohorts exhibited significant proportional increases from node-negative to node-positive disease (DC: odds ratio [OR], 1.047; P < 0.001; VC: OR, 1.035; P < 0.001) and improved OS (DC: hazard ratio [HR], 0.982; P < 0.001; VC: HR, 0.979; P < 0.001) as ELNs increased. Nodal staging scores escalated separately as ELNs increased for different tumor (T) stages, with plateaus at 16, 21, and 23 LNs (cut-offs) for T1, T2, and T3 tumors, respectively. Multivariable analysis indicated that examining more LNs than the corresponding cut-off value was a significant survival predictor (DC: HR, 0.813; P < 0.001; VC: HR, 0.696; P = 0.028). CONCLUSION The optimal number of ELNs for adequate staging of pancreatic cancer was related to T stage. We recommend examining at least 16, 21, and 23 LNs for T1, T2, and T3 tumors, respectively, as a nodal staging quality measure for both surgery and pathological analysis.
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Affiliation(s)
- Jie Hua
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Bo Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Jiang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Jin He
- Department of Surgery, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lei Zheng
- Department of Surgery, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China.
| | - Si Shi
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China.
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Xu Y, Li H, Tong X, Pang Y, Tong X, Li L, Cheng L. How to evaluate the adequacy of staging for nodal-negative epithelial ovarian cancer? Use of nodal staging score. J Gynecol Oncol 2018; 30:e21. [PMID: 30740953 PMCID: PMC6393634 DOI: 10.3802/jgo.2019.30.e21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/24/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE No guideline has been provided to assess the minimal number of lymph nodes (LNs) that should be dissected for accurate staging in patients with epithelial ovarian cancer (EOC). The aim of the study was to develop a nodal staging score (NSS) as an index to assess whether a pathologic (p)N0 EOC patient is indeed free of a nodal disease. METHODS A total of 16,361 EOC patients staged I-III between 2004 and 2013 were identified from the Surveillance, Epidemiology and End Result database. With a β-binomial model, NSS was calculated to assess the probability of true-negative findings of LN status. RESULTS With an increased number of LNs examined, the probability of missing a nodal disease decreased and varied among different pT stages. Given 1 LN examined, an NSS of 93.76% calculated could ensure a high adequacy of nodal-negative classification for pT1N0 EOC patients. For pT2N0 patients, 5 LNs examined could guarantee an NSS of 90% for adequate staging. Likewise, 11 and 29 LNs examined in pT3N0 patients could maintain NSS at the level of 80% and 90%, respectively. Our study suggested the optimal number of LNs that could be examined and stratified by the pT stages for EOC patients based on this statistical model derived from large pathologic data of clinical surgery patients. CONCLUSION NSS, as an auxiliary tool, not only could assist the International Federation of Gynecology and Obstetrics staging more precisely, but also would provide a statistical basis for postoperative evaluation for further clinical decision-making.
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Affiliation(s)
- Yuan Xu
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Haoran Li
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoxia Tong
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yangyang Pang
- Department of Surgery, Jiading Central Hospital, Shanghai, China
| | - Xiaojuan Tong
- Department of General Family Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Luhong Li
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Lei Cheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
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Zhao S, Ma D, Huang Y, Zhang L, Cao Y, Wang Y. STARD: How many lymph nodals needed to be dissected in corpus carcinoma? Medicine (Baltimore) 2018; 97:e0260. [PMID: 29668578 PMCID: PMC5916645 DOI: 10.1097/md.0000000000010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
During corpus carcinoma surgery, there is uncertainty as to how many lymph nodes should be dissected and examined to determine lymph invasion.In this study, we evaluated a beta-binominal model in data extracted from the Surveillance, Epidemiology, and End Results (SEER) database, which contains 22,372 complete records. We quantified the relationship between examined node number and the probability of missing invaded nodes. Survival curves were used for further validation.We found that for stage T1-T4, 1, 10, 23, and 37 lymph nodes, respectively, needed to be examined to minimize the missing positive nodal probability (1-nodal staging score, NSS) to less than 5%. A hypothetical lymph node examination rate was calculated. Survival rate of T2 and T3 stage samples was significantly associated with NSS, but T1 and T4 sample survival rate was not.The currently dissected nodal should be reduced to 1 to 2 for T1, remains to 10 for T2, and increases to 23 for T3.
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Affiliation(s)
- Shuping Zhao
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Dehua Ma
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yu Huang
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Lei Zhang
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Yuan Cao
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Yawen Wang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Development and Internal Validation of a Novel Model to Identify the Candidates for Extended Pelvic Lymph Node Dissection in Prostate Cancer. Eur Urol 2017; 72:632-640. [DOI: 10.1016/j.eururo.2017.03.049] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/30/2017] [Indexed: 11/20/2022]
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Rieken M, Kluth LA, Seitz C, Abufaraj M, Foerster B, Mathieu R, Karakiewicz PI, Bachmann A, Briganti A, Rouprê M, Gönen M, Shariat SF, Seebacher V. External Validation of the Pathologic Nodal Staging Score for Prostate Cancer: A Population-based Study. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30243-4. [PMID: 28916272 PMCID: PMC8389142 DOI: 10.1016/j.clgc.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/06/2017] [Accepted: 08/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sought to externally validate our pathologic nodal staging score (pNSS) model, which allows for quantification of the likelihood that a pathologically node-negative patient will not have lymph node (LN) metastasis after radical prostatectomy for prostate cancer (PCa) in a population-based cohort. PATIENTS AND METHODS We analyzed data from 50,598 patients treated with radical prostatectomy and pelvic LN dissection using the Surveillance, Epidemiology, and End Results database. We estimated the sensitivity of pathologic nodal staging using a β-binomial model and developed a novel pNSS model, which represents the probability that a patient's PCa has been correctly staged as node negative as a function of the number of examined LNs. These findings were compared against those from the original cohort of 7135 patients. RESULTS The mean and median number of LNs removed was 6.5 and 5, respectively (range, 1-89; interquartile range, 2-8), and 96.9% of the patients (n = 49,020) had stage pN0. Similar to the original cohort, the probability of missing a positive LN decreased with the increasing number of LNs examined. In both the validation and the original cohort, the number of LNs needed to correctly stage a patient's disease as node negative increased with more advanced tumor stage, higher Gleason sum, positive surgical margins, and higher preoperative prostate-specific antigen levels. CONCLUSION We have confirmed that the number of examined LNs needed for adequate nodal staging in PCa depends on the pathologic tumor stage, Gleason sum, surgical margins status, and preoperative prostate-specific antigen. We externally validated our pNSS in a population-based cohort, which could help to refine decision-making regarding the administration of adjuvant therapy.
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Affiliation(s)
- Malte Rieken
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | | | - Alexander Bachmann
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Morgan Rouprê
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | - Veronika Seebacher
- Department for Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
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Gandaglia G, Fossati N, Dell'Oglio P, Montorsi F, Briganti A. Is there a role for pure clinical prediction models in prostate cancer in the contemporary era? BJU Int 2017; 119:652-653. [PMID: 28393494 DOI: 10.1111/bju.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, Urological Research Institute, L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Division of Oncology/Unit of Urology, Urological Research Institute, L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Prendeville S, van der Kwast TH. Lymph node staging in prostate cancer: perspective for the pathologist. J Clin Pathol 2016; 69:1039-1045. [PMID: 27555432 DOI: 10.1136/jclinpath-2016-203643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/30/2016] [Indexed: 11/03/2022]
Abstract
Pelvic lymph node dissection (PLND) currently represents the gold standard method for nodal staging in the setting of localised prostate cancer and may also have a therapeutic benefit in certain patients. The histopathological evaluation of PLND specimens plays a critical role in accurate lymph node staging, however there is currently a lack of consensus regarding the optimum approach and no quality parameters are in place. In addition, there are no guidelines as to the handling of less commonly encountered nodal specimens such as those identified within the anterior fat pad. This summary provides an overview of pertinent issues regarding lymph node staging in prostate cancer, with a focus on the histopathological evaluation of resected nodal specimens. We hope that this review will further the discussion on how to achieve a more standardised approach to the processing and reporting of PLND specimens in the setting of prostate cancer.
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Affiliation(s)
- Susan Prendeville
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Theodorus H van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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Abdollah F, Karnes RJ, Gandaglia G, Fossati N, Montorsi F, Briganti A. Reply to C.G. Rusthoven et al. J Clin Oncol 2015; 33:1989. [PMID: 25847935 DOI: 10.1200/jco.2015.60.9552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Firas Abdollah
- Vattikuti Urology Institute and Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI
| | | | - Giorgio Gandaglia
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
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Suardi N, Larcher A, Haese A, Ficarra V, Govorov A, Buffi NM, Walz J, Rocco B, Borghesi M, Steuber T, Pini G, Briganti A, Mottrie AM, Guazzoni G, Montorsi F, Pushkar D, Van Der Poel H. Indication for and Extension of Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy: An Analysis of Five European Institutions. Eur Urol 2014; 66:635-43. [DOI: 10.1016/j.eururo.2013.12.059] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/24/2013] [Indexed: 11/16/2022]
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Sentinel node biopsy for prostate cancer: a useless surgical exercise? Eur Urol 2014; 66:999-1000. [PMID: 25199716 DOI: 10.1016/j.eururo.2014.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
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Heidenreich A, Pfister D. Pelvic Lymphadenectomy in Clinically Localised Prostate Cancer: Counting Lymph Nodes or Dissecting Primary Landing Zones of the Prostate? Eur Urol 2014; 66:447-9. [DOI: 10.1016/j.eururo.2013.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment. Br J Cancer 2014; 111:213-9. [PMID: 25003663 PMCID: PMC4102948 DOI: 10.1038/bjc.2014.311] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status. METHODS We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes. RESULTS In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively. CONCLUSIONS Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.
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