Adherence to the lymphadenectomy recommendations of the 2009 clinical guidelines in the 2010 National Prostate Cancer Registry

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• 作者：F. Herranz-Amo^a ; ^{felipeherranz@telefonica.net" class="auth_mail" title="E-mail the corresponding author} ; C. Herná ; ndez-Ferná ; ndez^a ; J.M. Có ; zar Olmo^b ; B. Miñ ; ana-Ló ; pez^c ; F. Gó ; mez-Veiga^d ; A. Rodrí ; guez-Antolí ; n^e ; E. Pedrosa^f ; Grupo Españ ; ol de Cá ; ncer de Pró ; stata (GESCAP)
• 关键词：Prostate cancer ; Prostatectomy ; Lymphadenectomy ; Adherence to clinical guidelines ; Predictors of lymphadenectomy
• 刊名：Actas Urológicas Espa?olas (English Edition)
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：39
• 期：9
• 页码：546-552
• 全文大小：442 K

文摘

To assess the adherence to the recommendations of the 2009 clinical guidelines in the implementation of lymphadenectomy during radical prostatectomy and analysis of the variables that influence this decision in the 2010 National Prostate Cancer Registry.

Material and method

Analysis of 1272 patients who underwent prostatectomy in 25 national hospitals. Patient classification according to the pathological node-positive (pN+) risk criteria included in the clinical guidelines of the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN). Calculation of the raw agreement and index of agreement kappa. Logistic regression to assess the predictors in the decision to perform lymphadenectomy.

Results

Lymphadenectomy was performed on 225 (17.7%) patients, with a variability among centers of 0–62.2% (p < 0.001). There was lymphocytic invasion (pN+) in 17 (7.5%) patients. The raw agreement with the EAU-09 clinical guidelines was 0.672 (0.48–0.96 in the various centers), and the kappa index was 0.289. The raw agreement with the NCCN-09 clinical guidelines was 0.814 (0.51–1 in the various centers), and the kappa index was 0.228. In the multivariate analysis, the independent predictors for performing lymphadenectomy were the Gleason score, the clinical stage, the prostate-specific antigen, the hospital center and the surgical approach route to prostatectomy (all p < 0.001).

Conclusions

In our study, adherence to the recommendations of the clinical guidelines on the implementation of lymphadenectomy was moderate. When deciding on lymphadenectomy, the determinants (in addition to the classic clinical variables) were the approach route and the hospital where the prostatectomy was performed.