Clinical versus pathologic staging for XXXX : how do they correlate?

@entity1 @entity263 @entity1486
OBJECTIVES: We assessed the ability of 3 clinical factors-stage, D'Amico risk stratification, and Roach formula-estimated nodal risk-to predict the pathologic outcomes in a modern @entity263 @entity1 . METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results Program for 2004 and 2005. @entity1 with @entity263 who had complete staging information were included. @entity1 were stratified according to the D'Amico criteria into low, intermediate, or high-risk groups using clinical T-stage, Gleason sum, and @entity1486 . Comparison was made with risk groups obtained after replacing clinical with pathologic T-stage. In addition, the Roach formula-predicted risk of positive lymph nodes was calculated and compared with the pathologic incidence of positive nodes. RESULTS: A total of 56,446 @entity1 were included, of whom 13,135 had a prostatectomy with complete pathologic staging. Of 3476 @entity1 with clinically palpable disease, who underwent prostatectomy, 2.5% were down-T-staged pathologically, whereas 34.7% were up-T-staged. Replacing clinical T-stage with pathologic T-stage in the D'Amico risk stratification resulted in the majority of @entity1 being up-risk-stratified to a higher risk group. Three hundred and forty-three @entity1 had positive nodes. The @entity1 with a Roach formula-predicted likelihood of positive nodes of 0% to 5%, 5.1% to 10%, 10.1% to 15%, and greater than 15% were found to have 0.2%, 0.5%, 1.2%, and 6.6% pathologic incidence of positive nodes, respectively. CONCLUSIONS: Pathologic staging results in higher risk stratification than that predicted by clinical criteria in the majority of @entity1 . Nodal positivity at diagnosis is uncommon in the current era, and the Roach formula overestimates the actual risk of node-positive disease.
