Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms
Abstract Background Pelvic lymph node dissection (PLND) is recommended method for detecting prostate cancer (PCa) nodal metastases although associated with serious complications. In this study, we aimed to assess benefit/harm of routine PLND in intermediate risk PCa patients and to compare diagnosti...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Urology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12894-023-01362-y |
| _version_ | 1797556139260379136 |
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| author | Branimir Lodeta Hrvoje Baric Dominik Hatz Danijel Jozipovic Herbert Augustin |
| author_facet | Branimir Lodeta Hrvoje Baric Dominik Hatz Danijel Jozipovic Herbert Augustin |
| author_sort | Branimir Lodeta |
| collection | DOAJ |
| description | Abstract Background Pelvic lymph node dissection (PLND) is recommended method for detecting prostate cancer (PCa) nodal metastases although associated with serious complications. In this study, we aimed to assess benefit/harm of routine PLND in intermediate risk PCa patients and to compare diagnostic yield of five different nomograms in predicting lymph node invasion (LNI). Methods Retrospective analysis of consecutive PCa patients with intermediate risk of biochemical recurrence who underwent open radical prostatectomy (RP) with bilateral PLND between January 2017 and December 2019 at our institution. Partin, 2012-Briganti, 2018-Briganti, Cagiannos and Memorial Sloan Kettering Cancer Center (MSKCC) values were calculated. To compare accuracy, sensitivity, specificity, and area under receiver-operating curve (AUC) were calculated and then optimal cutoff values were estimated, analyses repeated and compared. To assess benefit and harm of PLND, relative risk (RR) and number need to treat (NNT) with LNI and complications set as outcome were calculated. Results Total 309 subjects. Average age 62.2 years, average PSA 7.2 ng/mL; 18 (5.8%) had LNI; 88 (28.5%) suffered Clavien-Dindo grade 3–5 complication. AUC for predicting LNI: 0.729 for 2012-Briganti, 0.660 for MSKCC, 0.521 for 2018-Briganti, 0.486 for Cagiannos, and 0.424 for Partin. None of pairwise AUC comparisons based on default and newly established cutoff values were statistically significant. Lowest NNT was for Partin and Cagiannos with default cutoff (≥ 5%). Risks of serious complications between higher/lower than cutoff values were non-significant across nomograms. Conclusions 2012-Briganti nomogram outperforms, although not significantly, MSKCC, 2018-Briganti, Cagiannos, and Partin nomograms in classifying LNI in intermediate risk PCa patients. Routine PLND in these patients should be avoided, due to high rate and severity of complications. |
| first_indexed | 2024-03-10T16:57:33Z |
| format | Article |
| id | doaj.art-12d5a285a47d4013bb43848f6be3fcab |
| institution | Directory Open Access Journal |
| issn | 1471-2490 |
| language | English |
| last_indexed | 2024-03-10T16:57:33Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Urology |
| spelling | doaj.art-12d5a285a47d4013bb43848f6be3fcab2023-11-20T11:03:20ZengBMCBMC Urology1471-24902023-11-012311810.1186/s12894-023-01362-yBenefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomogramsBranimir Lodeta0Hrvoje Baric1Dominik Hatz2Danijel Jozipovic3Herbert Augustin4Privatklinik Maria HilfDepartment of Neurosurgery, Clinical Hospital Center ZagrebDepartment of Urology, Klinikum KlagenfurtDepartment of Urology, Klinikum KlagenfurtDepartment of Urology, Medical University of GrazAbstract Background Pelvic lymph node dissection (PLND) is recommended method for detecting prostate cancer (PCa) nodal metastases although associated with serious complications. In this study, we aimed to assess benefit/harm of routine PLND in intermediate risk PCa patients and to compare diagnostic yield of five different nomograms in predicting lymph node invasion (LNI). Methods Retrospective analysis of consecutive PCa patients with intermediate risk of biochemical recurrence who underwent open radical prostatectomy (RP) with bilateral PLND between January 2017 and December 2019 at our institution. Partin, 2012-Briganti, 2018-Briganti, Cagiannos and Memorial Sloan Kettering Cancer Center (MSKCC) values were calculated. To compare accuracy, sensitivity, specificity, and area under receiver-operating curve (AUC) were calculated and then optimal cutoff values were estimated, analyses repeated and compared. To assess benefit and harm of PLND, relative risk (RR) and number need to treat (NNT) with LNI and complications set as outcome were calculated. Results Total 309 subjects. Average age 62.2 years, average PSA 7.2 ng/mL; 18 (5.8%) had LNI; 88 (28.5%) suffered Clavien-Dindo grade 3–5 complication. AUC for predicting LNI: 0.729 for 2012-Briganti, 0.660 for MSKCC, 0.521 for 2018-Briganti, 0.486 for Cagiannos, and 0.424 for Partin. None of pairwise AUC comparisons based on default and newly established cutoff values were statistically significant. Lowest NNT was for Partin and Cagiannos with default cutoff (≥ 5%). Risks of serious complications between higher/lower than cutoff values were non-significant across nomograms. Conclusions 2012-Briganti nomogram outperforms, although not significantly, MSKCC, 2018-Briganti, Cagiannos, and Partin nomograms in classifying LNI in intermediate risk PCa patients. Routine PLND in these patients should be avoided, due to high rate and severity of complications.https://doi.org/10.1186/s12894-023-01362-yLymph node dissectionNomogramProstate cancerAccuracyComplications |
| spellingShingle | Branimir Lodeta Hrvoje Baric Dominik Hatz Danijel Jozipovic Herbert Augustin Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms BMC Urology Lymph node dissection Nomogram Prostate cancer Accuracy Complications |
| title | Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms |
| title_full | Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms |
| title_fullStr | Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms |
| title_full_unstemmed | Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms |
| title_short | Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms |
| title_sort | benefit and harm of lymphadenectomy in intermediate risk prostate cancer comparison of five nomograms |
| topic | Lymph node dissection Nomogram Prostate cancer Accuracy Complications |
| url | https://doi.org/10.1186/s12894-023-01362-y |
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