@Article{,
AUTHOR = {Firas Abdollah, Dane E. Klett, Jesse D. Sammon, 
Deepansh Dalela, Akshay Sood, Linda Hsu, 
Mireya Diaz, Nilesh Gupta, James O. Peabody, 
Quoc-Dien Trinh, Mani Menon},
TITLE = {Predicting lymph node invasion in patients  treated with robot-assisted radical  prostatectomy},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {23},
YEAR = {2016},
NUMBER = {1},
PAGES = {8141--8150},
URL = {http://www.techscience.com/CJU/v23n1/61188},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> To develop a nomogram to predict lymph 
node invasion (LNI) in the contemporary North American 
patient treated with robot-assisted radical prostatectomy 
(RARP).<br/>
<b>Materials and methods:</b> We included 2,007 patients 
treated with RARP and pelvic lymph node dissection 
(PLND) at a single institution between 2008 and 2012. 
D’Amico low risk patients underwent an obturator and 
hypogastric PLND, while extended PLND was reserved 
for intermediate/high risk patients. Logistic regression 
analysis tested the relationship between LNI and all 
available predictors. Independent predictors of LNI were 
used to develop a novel nomogram. Discrimination, 
calibration and decision-curve analysis were used to 
analyze the performance of our novel nomogram, and 
compare it to open radical prostatectomy (ORP)-based 
models, namely the Godoy nomogram. <br/>
<b>Results:</b> Overall, 5.3% of our patients harbored LNI. 
Median number of lymph nodes removed was 6.0 
(interquartile range: 4-11). The most parsimonious 
multivariable model to predict LNI consisted of the 
following independent predictors: PSA value, clinical 
stage, and primary and secondary Gleason scores (all 
p ≤ 0.02). The discrimination of our novel model was 
86.2%, and its calibration was virtually optimal. Using 
a 2% nomogram cut off, 58% of patients would be spared 
PLND, while missing only 9.4% of individuals with LNI. 
The novel nomogram compared favorably to the Godoy 
nomogram, when discrimination, calibration and net-benefit were used as benchmarks.<br/>
<b>Conclusions: </b>Approximately 5% of contemporary 
North American patients harbor LNI at RARP. Our 
novel nomogram can accurately identify these patients, 
and this may help to improve patient selection, and avoid 
unnecessary PLND in the majority of patients.},
DOI = {}
}