TY - JOUR
T1 - Clinicopathological predictors of finding additional inguinal lymph node metastases in penile cancer patients after positive dynamic sentinel node biopsy
T2 - a European multicentre evaluation
AU - de Vries, Hielke M.
AU - Lee, Hack Jae
AU - Lam, Wayne
AU - Djajadiningrat, Rosa S.
AU - Ottenhof, Sarah R.
AU - Roussel, Eduard
AU - Kroon, Bin Klaas
AU - de Jong, Igle Jan
AU - Oliveira, Pedro
AU - Alnajjar, Hussain M.
AU - Albersen, Maarten
AU - Muneer, Asif
AU - Sangar, Vijay
AU - Parnham, Arie
AU - Ayres, Benjamin
AU - Watkin, Nick
AU - Horenblas, Simon
AU - Stuiver, Martijn M.
AU - Brouwer, Oscar R.
N1 - Publisher Copyright: © 2021 The Authors BJU International © 2021 BJU International
PY - 2021
Y1 - 2021
N2 - Objective: To develop a predictive model for additional inguinal lymph node metastases (LNM) at inguinal lymph node dissection (ILND) after positive dynamic sentinel node biopsy (DSNB) using DSNB characteristics to identify a patient group in which ILND might be omitted. Patients and Methods: We conducted a retrospective study of 407 inguinal basins with a positive DSNB in penile cancer patients who underwent subsequent ILND from seven European centres. From the histopathology reports, the number of positive and negative lymph nodes, presence of extranodal extension and size of the metastasis were recorded. Using bootstrapped logistic regression, variables were selected for the clinical prediction model based on the optimization of Akaike's information criterion. The area under the curve (AUC) of the receiver-operating characteristic curve was calculated for the resulting model. Decision curve analysis (DCA) was used to evaluate the clinical utility of the model. Results: Of the positive DSNBs, 64 (16%) harboured additional LNM at ILND. Number of positive nodes at positive DSNB (odds ratio [OR] 2.19, 95% confidence interval (CI) 1.17–4.00; P = 0.01) and largest metastasis size in mm (OR 1.06, 95% CI 1.03–1.10; P = 0.001) were selected for the clinical prediction model. The AUC was 0.67 (95% CI 0.60–0.74). The DCA showed no clinical benefit of using the clinical prediction model. Conclusion: A small but clinically important group of basins harbour additional LNM at completion ILND after positive DSNB. While DSNB characteristics were associated with additional LNM, they did not improve the selection of basins in which ILND could be omitted. Thus, completion ILND remains necessary in all basins with a positive DSNB.
AB - Objective: To develop a predictive model for additional inguinal lymph node metastases (LNM) at inguinal lymph node dissection (ILND) after positive dynamic sentinel node biopsy (DSNB) using DSNB characteristics to identify a patient group in which ILND might be omitted. Patients and Methods: We conducted a retrospective study of 407 inguinal basins with a positive DSNB in penile cancer patients who underwent subsequent ILND from seven European centres. From the histopathology reports, the number of positive and negative lymph nodes, presence of extranodal extension and size of the metastasis were recorded. Using bootstrapped logistic regression, variables were selected for the clinical prediction model based on the optimization of Akaike's information criterion. The area under the curve (AUC) of the receiver-operating characteristic curve was calculated for the resulting model. Decision curve analysis (DCA) was used to evaluate the clinical utility of the model. Results: Of the positive DSNBs, 64 (16%) harboured additional LNM at ILND. Number of positive nodes at positive DSNB (odds ratio [OR] 2.19, 95% confidence interval (CI) 1.17–4.00; P = 0.01) and largest metastasis size in mm (OR 1.06, 95% CI 1.03–1.10; P = 0.001) were selected for the clinical prediction model. The AUC was 0.67 (95% CI 0.60–0.74). The DCA showed no clinical benefit of using the clinical prediction model. Conclusion: A small but clinically important group of basins harbour additional LNM at completion ILND after positive DSNB. While DSNB characteristics were associated with additional LNM, they did not improve the selection of basins in which ILND could be omitted. Thus, completion ILND remains necessary in all basins with a positive DSNB.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85122368962&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34927790
UR - http://www.scopus.com/inward/record.url?scp=85122368962&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bju.15678
DO - https://doi.org/10.1111/bju.15678
M3 - Article
C2 - 34927790
SN - 1464-4096
JO - BJU international
JF - BJU international
ER -