A population-based assessment of the National Comprehensive Cancer Network practice guideline indications for pelvic lymph node dissection at radical prostatectomy
A population-based assessment of the National Comprehensive Cancer Network practice guideline indications for pelvic lymph node dissection at radical prostatectomy
复制标题
DOI：
10.1111/j.1464-410x.2011.10518.x
复制
发表时间：
2012-04-01
影响因子：
4.5
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
--
作者：
Abdollah, Firas;Schmitges, Jan;Karakiewicz, Pierre I.
目的 检查国家综合癌症网络 (NCCN) 推荐的阈值在正确预测组织学证实的淋巴结侵犯 (LNI) 方面的能力。2010 年 NCCN 前列腺癌实践指南建议对列线图预测 LNI 风险 >= 2% 的所有个体在根治性前列腺切除术中进行盆腔淋巴结清扫术 (PLND)。患者和方法我们评估了 20 877 名接受治疗的患者2004 年至 2006 年间，在监测、流行病学和最终结果数据库中进行根治性前列腺切除术和 PLND。测试了 2% 列线图阈值以及其他阈值（范围 1-10%）。最后，我们在外部验证了 NCCN 指南列线图。结果总体而言，2.5% 的患者患有 LNI。使用 2% 阈值可以避免 23% PLND，代价是漏掉了 1.7% 的 LNI 患者。相反，使用 3% 阈值可以避免 58% 的 PLND，但代价是漏掉 15% 的 LNI 患者，而使用 4% 阈值时分别漏掉 72% 和 26% 的患者。总体而言，根据接受者-操作者特征导出的曲线下面积量化的 NCCN 指南列线图的准确性为 82%。结论在基于人群的样本中，NCCN指南列线图非常准确。然而，2% 的阈值只能避免 23% 的 PLND，而不是 NCCN 指南预期的 48%。使用 3% 的阈值可能会降低 PLND 过度治疗的发生率，尽管会漏掉更多的 LNI 患者。
OBJECTIVESTo examine the ability of the threshold recommended by the National Comprehensive Cancer Network (NCCN) in correctly predicting histologically-confirmed lymph node invasion (LNI).The 2010 NCCN practice guidelines for prostate cancer recommend a pelvic lymph node dissection (PLND) at radical prostatectomy in all individuals with a nomogram predicted LNI risk of >= 2%.PATIENTS AND METHODSWe assessed 20 877 patients who were treated with radical prostatectomy and PLND between 2004 and 2006, within the Surveillance, Epidemiology and End Results database.The 2% nomogram threshold, as well as other threshold values (range 1-10%) were tested.Finally, we externally validated the NCCN guideline nomogram.RESULTSOverall, 2.5% of patients had LNI.The use of the 2% threshold would allow the avoidance of 23% of PLNDs, at the cost of missing 1.7% of patients with LNI. Conversely, the use of a 3% threshold would allow the avoidance of 58% of PLNDs, at the cost of missing 15% of patients with LNI vs 72% and 26%, respectively, for the 4% threshold.Overall, the accuracy of the NCCN guideline nomogram quantified according to the receiver-operator characteristics-derived area under the curve was 82%.CONCLUSIONSIn a population-based sample, the NCCN guideline nomogram is highly accurate.However, the 2% threshold will permit the avoidance of only 23% of PLNDs, instead of the 48% intended by the NCCN guidelines.The use of a 3% threshold may allow a lower rate of PLND overtreatment, although it will miss more patients with LNI.