Partin Tables cannot accurately predict the pathological stage at radical prostatectomy

Bhojani, N.; Ahyai, S.; Graefen, M.; Capitanio, U.; Suardi, N.; Shariat, S.F.; Jeldres, C.; Erbersdobler, A.; Schlomm, T.; Haese, A.; Steuber, T.; Heinzer, H.; Montorsi, F.; Huland, H.; Karakiewicz, P.I.

doi:10.1016/j.ejso.2008.07.013

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 2 , Pages 123-128, February 2009

Partin Tables cannot accurately predict the pathological stage at radical prostatectomy

N. Bhojani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montréal, Québec, Canada
- Department of Urology, University of Montreal, Montreal, Canada
- Equal contribution.
S. Ahyai
- Department of Urology, University of Hamburg, Hamburg, Germany
- Equal contribution.
M. Graefen
- Department of Urology, University of Hamburg, Hamburg, Germany
U. Capitanio
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montréal, Québec, Canada
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
N. Suardi
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montréal, Québec, Canada
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
S.F. Shariat
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montréal, Québec, Canada
C. Jeldres
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montréal, Québec, Canada
- Department of Urology, University of Montreal, Montreal, Canada
A. Erbersdobler
- Department of Urology, University of Hamburg, Hamburg, Germany
T. Schlomm
- Department of Urology, University of Hamburg, Hamburg, Germany
A. Haese
- Department of Urology, University of Hamburg, Hamburg, Germany
T. Steuber
- Department of Urology, University of Hamburg, Hamburg, Germany
H. Heinzer
- Department of Urology, University of Hamburg, Hamburg, Germany
F. Montorsi
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
H. Huland
- Department of Urology, University of Hamburg, Hamburg, Germany
P.I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montréal, Québec, Canada
- Department of Urology, University of Montreal, Montreal, Canada
- Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, Rue St-Denis, Montréal, Québec H2X 3J4, Canada. Tel.: +1 514 890 8000 35336; fax: +1 514 412 7363.

Accepted 23 July 2008.

Abstract

Purpose

The Partin Tables represent the most commonly used staging tool for radical prostatectomy (RP) candidates. The Partin Tables' predictions are used to guide the type (nerve preserving RP) and/or the extent (RP with wide resection) of RP. We examined the ability of the Partin Tables' predictions incorrectly assigning the stage at RP.

Methods

The testing of the Partin Tables (external validation) was based on 3105 patients treated with RP at a single European institution. Standard validation metrics were used (area under the receiver operating characteristics curve, AUC) to test the three endpoints predicted by the Partin Tables, namely the presence of extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node invasion (LNI).

Results

Ideal predictions are denoted with 100% accuracy vs. 50% for entirely random predictions. For the 2001 version of the Tables the accuracy defined by the AUC was 79.7, 77.8, and 73.0 for ECE, SVI, and LNI, respectively. For the 2007 version of the Tables the corresponding accuracy estimates were 79.8, 80.5, and 76.2. The relationship between predicted probabilities and observed rates was poor.

Conclusion

The Partin Tables are meant to guide clinicians about the safety of nerve bundle preservation at RP, about the need for seminal vesicle resection or for lymphadenectomy. Therefore, the use of the Partin Tables predictions may significantly affect the type and/or the extent of RP. In their present format the Partin Tables are not accurate enough to influence the pre-operative decision making regarding the type or extent of RP.

Keywords: Prostate cancer, Staging, Radical prostatectomy