Strahlenther Onkol. 2021 Sep 02; doi: 10.1007/s00066-021-01841-x. Epub 2021 Sep 02.

On the probability of lymph node negativity in pN0-staged prostate cancer-a theoretically derived rule of thumb for adjuvant needs.

Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]

Frank Paulsen, Jens Bedke, Daniel Wegener, Jolanta Marzec, Peter Martus, Dominik Nann, Arnulf Stenzl, Daniel Zips, Arndt-Christian Müller

PMID: 34476527 DOI: 10.1007/s00066-021-01841-x

Abstract

PURPOSE: The extent of lymphadenectomy and clinical features influence the risk of occult nodes in node-negative prostate cancer. We derived a simple estimation model for the negative predictive value (npv) of histopathologically node-negative prostate cancer patients (pN0) to guide adjuvant treatment.

METHODS: Approximations of sensitivities in detecting lymph node metastasis from current publications depending on the number of removed lymph nodes were used for a theoretical deduction of a simplified formulation of npv assuming a false node positivity of 0.

RESULTS: A theoretical formula of npv = p(N0IpN0) = (100 - prevalence) / (100 - sensitivity × prevalence) was calculated (sensitivity and preoperative prevalence in %). Depending on the number of removed lymph nodes (nLN), the sensitivity of pN0-staged prostate cancer was derived for three sensitivity levels accordingly: sensitivity = f(nLN) = 9 × nLN /100 for 0 ≤ nLN ≤ 8 and f(nLN) = (nLN + 70) /100 for 9 ≤ nLN ≤ 29 and f(nLN) = 1 for nLN ≥ 30.

CONCLUSION: We developed a theoretical formula for estimation of the npv in pN0-staged prostate cancer patients. It is a sine qua non to use the formula in a clinically experienced context before deciding to electively irradiate pelvic lymph nodes or to intensify adjuvant systemic treatment.

© 2021. The Author(s).

Keywords: Negative predictive value; Nodal metastasis; Prediction model; Sensitivity; Whole-pelvis radiotherapy

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