Document Detail


Head-to-head Comparison of Three Commonly Used Preoperative Tools for Prediction of Lymph Node Invasion at Radical Prostatectomy.
MedLine Citation:
PMID:  22137704     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: A formal validation and head-to-head comparison of the National Comprehensive Cancer Network (NCCN) practice guideline lymph node invasion (LNI) nomogram, Partin tables, and D'Amico risk-classification was conducted for prediction of LNI at radical prostatectomy (RP).
METHODS: We focused on 20,877 patients treated with RP and pelvic lymph node dissection (PLND) between 2004 and 2006 within the Surveillance, Epidemiology and End Results database. The discrimination of the 3 tools in predicting histologically confirmed LNI was quantified using the area under the curve (AUC). Calibration plots were used to graphically depict the performance characteristics of the examined tools. In addition, we relied on decision curve analyses to compare the 3 models directly in a head-to-head fashion.
RESULTS: Overall, 2.5% of patients had LNI. The NCCN LNI nomogram (AUC 82%) outperformed the Partin tables (73%) and the D'Amico risk-classification (75%) for prediction of LNI. Calibration plots revealed that all 3 tools overestimated the risk of LNI. Partin tables showed the highest net-benefit for probability threshold range between 1% and 4%. Conversely, the NCCN LNI nomogram showed the highest net-benefit for the remaining threshold probabilities.
CONCLUSION: The NCCN LNI nomogram had the highest discrimination accuracy. However, using the decision curve analysis, the Partin tables demonstrated the highest net benefit when a threshold probability of LNI is <4%. In contrast, the NCCN LNI nomogram had the highest net benefit when the threshold probability used to perform PLND is greater than 4%.
Authors:
Firas Abdollah; Jan Schmitges; Maxine Sun; Rodolphe Thuret; Orchidee Djahangirian; Zhe Tian; Shahrokh F Shariat; Alberto Briganti; Paul Perrotte; Francesco Montorsi; Pierre I Karakiewicz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Urology     Volume:  78     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1363-7     Citation Subset:  IM    
Copyright Information:
Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Centre, Montreal, Canada; Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
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