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Pelvic lymph node dissection for prostate cancer: Adherence and accuracy of the recent guidelines
Author(s) -
Abdollah Firas,
Abdo Al'a,
Sun Maxine,
Schmitges Jan,
Tian Zhe,
Briganti Alberto,
Shariat Shahrokh F,
Perrotte Paul,
Montorsi Francesco,
Karakiewicz Pierre I
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2012.03171.x
Subject(s) - medicine , prostatectomy , lymph node , prostate cancer , cancer
Objectives The 2004 N ational C omprehensive C ancer N etwork practice guidelines recommend pelvic lymph node dissection at radical prostatectomy. We sought to examine the adherence to the 2004 N ational C omprehensive C ancer N etwork guidelines and to test the their accuracy, as well as the accuracy of the most contemporary N ational C omprehensive C ancer N etwork, A merican U rological A ssociation, and E uropean A ssociation of U rology guidelines to predict lymph node metastases. Methods A total of 33 037 radical prostatectomy patients were identified, between 2004 and 2006. Adherence to the 2004 N ational C omprehensive C ancer N etwork guidelines was calculated using three clinically plausible cut‐offs: 2, 5 and 10%. The accuracy was tested using the area under the curve. Results Overall, 63% of patients underwent pelvic lymph node dissection. Of those, 61, 49 and 45% were managed according to the 2004 N ational C omprehensive C ancer N etwork guideline cut‐off of 2, 5 and 10%, respectively. The accuracy of all the examined guidelines ranged from 61% to 71%. The highest accuracy was recorded for the E uropean A ssociation of U rology and the 2004 N ational C omprehensive C ancer N etwork cut‐off 5% guidelines. The lowest accuracy was recorded for the most contemporary N ational C omprehensive C ancer N etwork guideline. Conclusions Adherence to the 2004 N ational C omprehensive C ancer N etwork guidelines was suboptimal. The accuracy of all the examined guidelines ranged from 61% to 71%. None of the examined guidelines can be regarded as an ideal indication for pelvic lymph node dissection.