Predicting the risk of pelvic node involvement among men with prostate cancer in the contemporary era. Export

@article{citeulike:5065688, abstract = {PURPOSE: The "Roach formula" for the risk of pelvic lymph node metastases [(2/3) ( *) PSA + (Gleason score - 6) ( *) 10] was developed in the early prostate-specific antigen (PSA) era. We examined the accuracy of this formula in contemporary patients. METHODS: We included men in the Surveillance, Epidemiology, and End Results Registry with a diagnosis of clinical T1c-T4 prostate cancer in 2004 who had a surgical lymph node evaluation, Gleason score (typically from prostatectomy), and baseline PSA level (n = 9,387). Expected and observed rates of node positivity were compared. RESULTS: Ninety-eight percent were clinical T1c/T2, and 97\% underwent prostatectomy. Overall, 309 patients (3.29\%) had positive lymph nodes. Roach scores overestimated the actual rate of positive lymph nodes in the derivation set by 16-fold for patients with Roach score less than or equal to 10\%, by 7-fold for scores greater than 10-20\%, and by approximately 2.5-fold for scores greater than 20\%. Applying these adjustment factors to Roach scores in the validation data set yielded accurate predictions of risk. For those with Roach score less than or equal to 10\%, adjusted expected risk was 0.2\% and observed risk was 0.2\%. For Roach score greater than 10-20\%, adjusted expected risk was 2.0\% and observed risk was 2.1\%. For Roach score greater than 20-30\%, adjusted expected risk was 9.7\% and observed risk was 6.5\%. For Roach score greater than 30-40\%, adjusted expected risk was 13.9\% and observed risk was 13.9\%. CONCLUSION: Applied to contemporary patients with mainly T1c/T2 disease, the Roach formula appears to overestimate pelvic lymph node risk. The adjustment factors presented here should be validated by using biopsy Gleason scores and extended lymphadenectomies.}, author = {Nguyen, P. L. and Chen, M. H. and Hoffman, K. E. and Katz, M. S. and D'Amico, A. V.}, citeulike-article-id = {5065688}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.ijrobp.2008.07.053}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19286330}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19286330}, day = {1}, doi = {10.1016/j.ijrobp.2008.07.053}, issn = {1879-355X}, journal = {International journal of radiation oncology, biology, physics}, keywords = {nodes, prediction, prostate}, month = {May}, number = {1}, pages = {104--109}, posted-at = {2009-07-05 17:24:53}, priority = {2}, title = {Predicting the risk of pelvic node involvement among men with prostate cancer in the contemporary era.}, url = {http://dx.doi.org/10.1016/j.ijrobp.2008.07.053}, volume = {74}, year = {2009} }

TY - JOUR ID - citeulike:5065688 L3 - citeulike-article-id:5065688 N2 - PURPOSE: The "Roach formula" for the risk of pelvic lymph node metastases [(2/3) ( *) PSA + (Gleason score - 6) ( *) 10] was developed in the early prostate-specific antigen (PSA) era. We examined the accuracy of this formula in contemporary patients. METHODS: We included men in the Surveillance, Epidemiology, and End Results Registry with a diagnosis of clinical T1c-T4 prostate cancer in 2004 who had a surgical lymph node evaluation, Gleason score (typically from prostatectomy), and baseline PSA level (n = 9,387). Expected and observed rates of node positivity were compared. RESULTS: Ninety-eight percent were clinical T1c/T2, and 97% underwent prostatectomy. Overall, 309 patients (3.29%) had positive lymph nodes. Roach scores overestimated the actual rate of positive lymph nodes in the derivation set by 16-fold for patients with Roach score less than or equal to 10%, by 7-fold for scores greater than 10-20%, and by approximately 2.5-fold for scores greater than 20%. Applying these adjustment factors to Roach scores in the validation data set yielded accurate predictions of risk. For those with Roach score less than or equal to 10%, adjusted expected risk was 0.2% and observed risk was 0.2%. For Roach score greater than 10-20%, adjusted expected risk was 2.0% and observed risk was 2.1%. For Roach score greater than 20-30%, adjusted expected risk was 9.7% and observed risk was 6.5%. For Roach score greater than 30-40%, adjusted expected risk was 13.9% and observed risk was 13.9%. CONCLUSION: Applied to contemporary patients with mainly T1c/T2 disease, the Roach formula appears to overestimate pelvic lymph node risk. The adjustment factors presented here should be validated by using biopsy Gleason scores and extended lymphadenectomies. IS - 1 JF - International journal of radiation oncology, biology, physics SN - 1879-355X EP - 109 TI - Predicting the risk of pelvic node involvement among men with prostate cancer in the contemporary era. VL - 74 SP - 104 KW - nodes KW - prediction KW - prostate AU - Nguyen, PL AU - Chen, MH AU - Hoffman, KE AU - Katz, MS AU - D'Amico, AV PY - 2009/05/01/ UR - http://dx.doi.org/10.1016/j.ijrobp.2008.07.053 ER -