Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment.

BACKGROUND: Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status. METHODS: We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes. RESULTS: In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively. CONCLUSIONS: Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.

[Change in the income status of the disabled after introduction of long-term care insurance]. / Veränderung der Einkommenssituation von Pflegebedürftigen nach Einführung einer Pflegeversicherung.

Up to the present time, long-term-care needs in the Federal Republic of Germany have only been covered to a limited extent through health insurance. The needs of the majority of those requiring long-term care must be covered from their pension funds or acquired wealth. This often does not suffice, which results in those needing long-term care becoming recipients of social assistance. The introduction of a long-term-care insurance should bring an end to this situation, which is considered unacceptable. At present, two competing schemes for covering the social risk of long-term care are being discussed: a social security insurance and a private insurance. When comparing the planned benefits under consideration, the social security insurance is more favorable in regards to nursing-home treatment, as well as with at-home care and benefits in kind. The private insurance is more favorable when considering nursing-home treatment and monetary benefits. If the private insurance is adopted, over 31% of those formerly relying on nursing-home care would no longer need social assistance. In the case of social security insurance, almost 46% would no longer require social assistance. Most of the remaining individuals requiring social assistance would be women.