The use of artificial intelligence technology to predict lymph node spread in men with clinically localized prostate carcinoma
✍ Scribed by E. David Crawford; Joseph T. Batuello; Peter Snow; Eduard J. Gamito; David G. McLeod; Alan W. Partin; Nelson Stone; James Montie; Richard Stock; John Lynch; Jeff Brandt
- Publisher
- John Wiley and Sons
- Year
- 2000
- Tongue
- English
- Weight
- 79 KB
- Volume
- 88
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
BACKGROUND.
The current study assesses artificial intelligence methods to identify prostate carcinoma patients at low risk for lymph node spread. If patients can be assigned accurately to a low risk group, unnecessary lymph node dissections can be avoided, thereby reducing morbidity and costs.
METHODS.
A rule-derivation technology for simple decision-tree analysis was trained and validated using patient data from a large database (4133 patients) to derive low risk cutoff values for Gleason sum and prostate specific antigen (PSA)
level. An empiric analysis was used to derive a low risk cutoff value for clinical TNM stage. These cutoff values then were applied to 2 additional, smaller databases (227 and 330 patients, respectively) from separate institutions.
RESULTS.
The decision-tree protocol derived cutoff values of Յ 6 for Gleason sum and Յ 10.6 ng/mL for PSA. The empiric analysis yielded a clinical TNM stage low risk cutoff value of Յ T2a. When these cutoff values were applied to the larger database, 44% of patients were classified as being at low risk for lymph node metastases (0.8% false-negative rate). When the same cutoff values were applied to the smaller databases, between 11 and 43% of patients were classified as low risk with a false-negative rate of between 0.0 and 0.7%.
CONCLUSIONS.
The results of the current study indicate that a population of prostate carcinoma patients at low risk for lymph node metastases can be identified accurately using a simple decision algorithm that considers preoperative PSA, Gleason sum, and clinical TNM stage. The risk of lymph node metastases in these patients is Յ 1%; therefore, pelvic lymph node dissection may be avoided safely.
The implications of these findings in surgical and nonsurgical treatment are significant.