Radikal prostatektomi yapılan hastalarda lenf nodu invazyonunu öngören preoperatif nomogramların karşılaştırılması

Yıl 2023, Cilt: 15 Sayı: 1, 16 - 22, 30.01.2023

Osman Can , Cemal Topal , Eyyüp Danış , Muammer Bozkurt , Emin Taha Keskin , Halil Lütfi Canat , Abdulmuttalip Şimşek

https://doi.org/10.54233/endouroloji.1202615

Öz

Amaç: Prostat kanserinin cerrahi tedavisinde radikal prostatektomiye bazı durumlarda pelvik lenf nodu diseksiyonu (PLND) da eklenmektedir. Hangi hastada PLND yapılması gerektiğini öngören bazı nomogramlar geliştirilmiştir. Çalışmamızda MSKCC, Briganti ve Partin nomogramlarının etkinliğini değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Retrospektif olarak çalışmaya Eylül 2020 ile Ekim 2022 tarihleri arasında radikal prostatektomi ve PLND yapılmış prostat kanseri hastaları dahil edildi. Çalışmaya toplamda 94 hasta dahil edildi. Hastaların demografik verileri ve prostat spesifik antijen (PSA), klinik evre, gleason skoru, biyopsi özellikleri gibi verileri kullanılarak Briganti, MSKCC ve Partin nomogramına göre lenf nodu invazyonu oranları hesaplandı.
Bulgular: Radikal prostatektomi yapılan 94 hasta çalışmaya dahil edildi. Hastaların 15’inde lenf nodu invazyonu bildirilirken, 79 hastada saptanmadı. Hastaların Briganti, Partin ve MSKCC nomogramlarının eğri altında kalan alan değerleri sırasıyla 0,922, 0,825 ve 0,929 idi. Her 3 nomogramın doğruluk oranı istatistiksel olarak anlamlı şekilde başarılı idi.
Sonuç: MSKCC ve Briganti nomogramlarının lenf nodu invazyonunu öngörmedeki duyarlılığı Partine göre biraz daha yüksek bulunmuştur. Ancak Briganti, Partin’e ve MSKCC nomogramları prostat kanseri hastalarında lenf nodu invazyonunu öngörmede güvenle kullanılabilir.

Anahtar Kelimeler

Partin, MSKCC, Briganti, Prostat Kanseri

Comparison of preoperative nomograms predicting lymph node invasion in patients underwent radical prostatectomy

Öz

Objective: In some cases, pelvic lymph node dissection (PLND) is added to radical prostatectomy in the surgical treatment of prostate cancer. Some nomograms have been developed to predict which patient should undergo PLND. In our study, we aimed to evaluate the effectiveness of MSKCC, Briganti and Partin nomograms.
Material and Methods: Retrospectively, prostate cancer patients who underwent radical prostatectomy and PLND between September 2020 and October 2022 were included in the study. A total of 94 patients were included in the study. The rates of lymph node invasion were calculated according to the Briganti, MSKCC, and Partin nomograms using the demographic data of the patients and data such as prostate-specific antigen (PSA), clinical stage, gleason score, and biopsy characteristics.
Results: Ninety four patients who had radical prostatectomy were included in the study. While lymph node invasion was reported in 15 of the patients, it was not detected in 79 patients. The area under the curve (AUC)’s of the patients’ Briganti, Partin, and MSKCC nomograms were 0.922, 0.825, and 0.929, respectively. The accuracy rate of all 3 nomograms was statistically significant.
Conclusion: The sensitivity of MSKCC and Briganti nomograms in predicting lymph node invasion was found to be slightly higher than Partin nomogram. However, Briganti, Partin, and MSKCC nomograms can be used safely to predict lymph node invasion in prostate cancer patients.

Anahtar Kelimeler

Partin, MSKCC, Briganti, Prostate cancer

Kaynakça

• Culp MBB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol. 2020;77(1).
• Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017;71(4).
• Fossati N, Willemse PPM, Van den Broeck T, et al. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur Urol. 2017;72(1).
• Withrow DR, Degroot JM, Siemens DR, Groome PA. Therapeutic value of lymph node dissection at radical prostatectomy: A population-based case-cohort study. BJU Int. 2011;108(2).
• Briganti A, Larcher A, Abdollah F, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur Urol. 2012;61(3).
• Cagiannos I, Karakiewicz P, Eastham JA, et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol. 2003;170(5).
• Makarov D V., Trock BJ, Humphreys EB, et al. Updated Nomogram to Predict Pathologic Stage of Prostate Cancer Given Prostate-Specific Antigen Level, Clinical Stage, and Biopsy Gleason Score (Partin Tables) Based on Cases from 2000 to 2005. Urology. 2007;69(6).
• Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: High incidence of lymph node metastasis. J Urol. 2002;167(4 I).
• Abdollah F, Gandaglia G, Suardi N, et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol. 2015;67(2). Schoots IG, Padhani AR. Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated? World J Urol. 2020;38(3).
• Tosoian JJ, Chappidi M, Feng Z, et al. Prediction of pathological stage based on clinical stage, serum prostate-specific antigen, and biopsy Gleason score: Partin Tables in the contemporary era. BJU Int. 2017;119(5).
• Walz J, Bladou F, Rousseau B, et al. Head to head comparison of nomograms predicting probability of lymph node invasion of prostate cancer in patients undergoing extended pelvic lymph node dissection. Urology. 2012;79(3).
• Cimino S, Reale G, Castelli T, et al. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol. 2017;51(5).
• Oderda M, Diamand R, Albisinni S, et al. Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion. BJU Int. 2021;127(3).
• Gandaglia G, Ploussard G, Valerio M, et al. A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies. Eur Urol. 2019;75(3).
• Middleton RG. Value of and indications for pelvic lymph node dissection in the staging of prostate cancer. NCI Monogr. 1988;(7). Thomas R, Steele R, Smith R, Brannan W. One-stage laparoscopic pelvic lymphadenectomy and radical perineal prostatectomy. J Urol. 1994;152(4).
• Fowler JE, Torgerson L, McLeod DG, Stutzman RE. Radical prostatectomy with pelvic lymphadenectomy: observations on the accuracy of staging with lymphnode frozen sections. J Urol. 1981;126(5).
• Briganti A, Chun FKH, Salonia A, et al. Validation of a Nomogram Predicting the Probability of Lymph Node Invasion among Patients Undergoing Radical Prostatectomy and an Extended Pelvic Lymphadenectomy. Eur Urol. 2006;49(6).
• Touijer K, Rabbani F, Otero JR, et al. Standard Versus Limited Pelvic Lymph Node Dissection for Prostate Cancer in Patients With a Predicted Probability of Nodal Metastasis Greater Than 1%. J Urol. 2007;178(1).
• Clark T, Parekh DJ, Cookson MS, et al. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol. 2003;169(1).
• Mattei A, Fuechsel FG, Bhatta Dhar N, et al. The Template of the Primary Lymphatic Landing Sites of the Prostate Should Be Revisited: Results of a Multimodality Mapping Study. Eur Urol. 2008;53(1).
• Heidenreich A, Pfister D, Thüer D, Brehmer B. Percentage of positive biopsies predicts lymph node involvement in men with low-risk prostate cancer undergoing radical prostatectomy and extended pelvic lymphadenectomy. BJU Int. 2011;107(2).