The estimated prevalence of missed positive lymph nodes based on extent of lymphadenectomy at radical prostatectomy

Nicholas H. Chakiryan, Ann Martinez Acevedo, Michael Conlin, Mark Garzotto, Yiyi Chen, Jen Jane Liu, Christopher Amling, Ryan Kopp

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Abstract

Purpose: To determine practice patterns for the extent of lymphadenectomy at radical prostatectomy and associations with detection of pN1 prostate cancer, as well as the impact of lymphadenectomy extent on underdetection of pN1 disease and overall survival. Materials and methods: Prostatectomy cases in the NCDB from 2004 to 2013 were included. Lymphadenectomy extent was defined by the number of nodes examined. Logistic regression was used to identify risk factors for the top quartile of lymph node count and pN1 disease. This model was created to estimate the expected prevalence of pN1, and generated observed over expected ratios. A Cox regression model was used to evaluate the effect of lymph node count on overall survival. Results: Lymphadenectomy was performed in 209,789 (60%) of 358,522 surgeries, with pN1 in 6,428 (3.08%). Increasing quartiles for lymph node count was associated with pN1 (3–5 nodes OR 2.11; 6–8 nodes OR 3.12; ≥9 nodes OR 5.91, all P< 0.001). The logistic regression model suggested that 59% of pN1 cases are missed due to low lymph node count. Increased lymph node count was associated with increasing pN1 detection (O/E: 1–2 nodes = 0.18; 3–5 nodes = 0.37; 6–8 nodes = 0.56; ≥9 nodes = 1.01). Cox proportional hazards modeling demonstrated that the top quartile for lymph node count had improved overall survival (HR 0.93, CI 0.87–0.99, P= 0.03). Conclusions: Increasing lymphadenectomy extent was associated with pN1 disease on multivariate analysis, and logistic regression modeling suggested a substantial proportion of pN1 were missed due to low lymphadenectomy extent across all risk groups.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StatePublished - Jan 1 2019

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Prostatectomy
Lymph Node Excision
Lymph Nodes
Logistic Models
Proportional Hazards Models
Prostatic Neoplasms
Multivariate Analysis

Keywords

  • Lymph node dissection
  • Lymphadenectomy
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{b29d589cb93942318546121270fe78ab,
title = "The estimated prevalence of missed positive lymph nodes based on extent of lymphadenectomy at radical prostatectomy",
abstract = "Purpose: To determine practice patterns for the extent of lymphadenectomy at radical prostatectomy and associations with detection of pN1 prostate cancer, as well as the impact of lymphadenectomy extent on underdetection of pN1 disease and overall survival. Materials and methods: Prostatectomy cases in the NCDB from 2004 to 2013 were included. Lymphadenectomy extent was defined by the number of nodes examined. Logistic regression was used to identify risk factors for the top quartile of lymph node count and pN1 disease. This model was created to estimate the expected prevalence of pN1, and generated observed over expected ratios. A Cox regression model was used to evaluate the effect of lymph node count on overall survival. Results: Lymphadenectomy was performed in 209,789 (60{\%}) of 358,522 surgeries, with pN1 in 6,428 (3.08{\%}). Increasing quartiles for lymph node count was associated with pN1 (3–5 nodes OR 2.11; 6–8 nodes OR 3.12; ≥9 nodes OR 5.91, all P< 0.001). The logistic regression model suggested that 59{\%} of pN1 cases are missed due to low lymph node count. Increased lymph node count was associated with increasing pN1 detection (O/E: 1–2 nodes = 0.18; 3–5 nodes = 0.37; 6–8 nodes = 0.56; ≥9 nodes = 1.01). Cox proportional hazards modeling demonstrated that the top quartile for lymph node count had improved overall survival (HR 0.93, CI 0.87–0.99, P= 0.03). Conclusions: Increasing lymphadenectomy extent was associated with pN1 disease on multivariate analysis, and logistic regression modeling suggested a substantial proportion of pN1 were missed due to low lymphadenectomy extent across all risk groups.",
keywords = "Lymph node dissection, Lymphadenectomy, Prostate cancer",
author = "Chakiryan, {Nicholas H.} and Acevedo, {Ann Martinez} and Michael Conlin and Mark Garzotto and Yiyi Chen and Liu, {Jen Jane} and Christopher Amling and Ryan Kopp",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2019.06.008",
language = "English (US)",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - The estimated prevalence of missed positive lymph nodes based on extent of lymphadenectomy at radical prostatectomy

AU - Chakiryan, Nicholas H.

AU - Acevedo, Ann Martinez

AU - Conlin, Michael

AU - Garzotto, Mark

AU - Chen, Yiyi

AU - Liu, Jen Jane

AU - Amling, Christopher

AU - Kopp, Ryan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To determine practice patterns for the extent of lymphadenectomy at radical prostatectomy and associations with detection of pN1 prostate cancer, as well as the impact of lymphadenectomy extent on underdetection of pN1 disease and overall survival. Materials and methods: Prostatectomy cases in the NCDB from 2004 to 2013 were included. Lymphadenectomy extent was defined by the number of nodes examined. Logistic regression was used to identify risk factors for the top quartile of lymph node count and pN1 disease. This model was created to estimate the expected prevalence of pN1, and generated observed over expected ratios. A Cox regression model was used to evaluate the effect of lymph node count on overall survival. Results: Lymphadenectomy was performed in 209,789 (60%) of 358,522 surgeries, with pN1 in 6,428 (3.08%). Increasing quartiles for lymph node count was associated with pN1 (3–5 nodes OR 2.11; 6–8 nodes OR 3.12; ≥9 nodes OR 5.91, all P< 0.001). The logistic regression model suggested that 59% of pN1 cases are missed due to low lymph node count. Increased lymph node count was associated with increasing pN1 detection (O/E: 1–2 nodes = 0.18; 3–5 nodes = 0.37; 6–8 nodes = 0.56; ≥9 nodes = 1.01). Cox proportional hazards modeling demonstrated that the top quartile for lymph node count had improved overall survival (HR 0.93, CI 0.87–0.99, P= 0.03). Conclusions: Increasing lymphadenectomy extent was associated with pN1 disease on multivariate analysis, and logistic regression modeling suggested a substantial proportion of pN1 were missed due to low lymphadenectomy extent across all risk groups.

AB - Purpose: To determine practice patterns for the extent of lymphadenectomy at radical prostatectomy and associations with detection of pN1 prostate cancer, as well as the impact of lymphadenectomy extent on underdetection of pN1 disease and overall survival. Materials and methods: Prostatectomy cases in the NCDB from 2004 to 2013 were included. Lymphadenectomy extent was defined by the number of nodes examined. Logistic regression was used to identify risk factors for the top quartile of lymph node count and pN1 disease. This model was created to estimate the expected prevalence of pN1, and generated observed over expected ratios. A Cox regression model was used to evaluate the effect of lymph node count on overall survival. Results: Lymphadenectomy was performed in 209,789 (60%) of 358,522 surgeries, with pN1 in 6,428 (3.08%). Increasing quartiles for lymph node count was associated with pN1 (3–5 nodes OR 2.11; 6–8 nodes OR 3.12; ≥9 nodes OR 5.91, all P< 0.001). The logistic regression model suggested that 59% of pN1 cases are missed due to low lymph node count. Increased lymph node count was associated with increasing pN1 detection (O/E: 1–2 nodes = 0.18; 3–5 nodes = 0.37; 6–8 nodes = 0.56; ≥9 nodes = 1.01). Cox proportional hazards modeling demonstrated that the top quartile for lymph node count had improved overall survival (HR 0.93, CI 0.87–0.99, P= 0.03). Conclusions: Increasing lymphadenectomy extent was associated with pN1 disease on multivariate analysis, and logistic regression modeling suggested a substantial proportion of pN1 were missed due to low lymphadenectomy extent across all risk groups.

KW - Lymph node dissection

KW - Lymphadenectomy

KW - Prostate cancer

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U2 - 10.1016/j.urolonc.2019.06.008

DO - 10.1016/j.urolonc.2019.06.008

M3 - Article

AN - SCOPUS:85068439885

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

SN - 1078-1439

ER -