Title: Three or more positive nodes at radical prostatectomy represent a significant cut-off value for css in high-risk prostate cancer, while 1 or 2 positive nodes do not influence css
Authors: Joniau, Steven
Van Baelen, Anthony
Gontero, P
Briganti, A
Marchioro, G
Capitanio, U
Tombal, B
Hsu, C. Y
Akdogan, B
Bader, P
Frea, B
Frohneberg, D
Kneitz, B
Riedmiller, H
Tizzani, A
Van Poppel, Hendrik
Spahn, M #
Issue Date: Mar-2011
Publisher: Elsevier science bv
Host Document: European urology supplements vol:10 issue:2 pages:323-323
Conference: Annual Congress of the European Association of Urology edition:26 location:Vienna, Austria date:18-22 March 2011
Article number: 1046
Abstract: Introduction & Objectives: The finding of nodal metastases (N+) at the time of radical prostatectomy (RP) and pelvic lymph node dissection (PLND ) correlates with worse cancer specific survival (CSS). However, within the population of N+ patients, a more detailed risk stratification based on the number of nodes affected is not incorporated in the 2002 AJCC staging system. The purpose of this study was to evaluate whether a significant improvement in CSS rediction could be achieved when considering cut-offs of 0 vs. 1-2 vs. >= 3 affected nodes in a highrisk PCa population.

Materials & Methods: We retrospectively analyzed our institutional RP databases and included all consecutive patients with high-risk localized prostate cancer defined as >=cT3a OR PSA>20ng/ml OR biopsy Gleason score >=8. After showing a negative bone scan, all patients underwent a RP with a PLND. Patients in whom the number of removed nodes was known were used for further analysis. CSS was calculated for all patients using cut-offs for the number of tumor bearing nodes (0 vs. 1-2 vs. >=3 or more). Kaplan-Meier analysis with log rank test and a Cox multivariable model were used for the outcome analysis.

Results: Between April 1987 and April 2009, 781 patients with cT3-4 OR PSA>20ng/ml OR biopsy Gleason score >= 8 underwent RP with PLND at five European institutions. Mean age was 65.5 years (Median 66, IQR 61-70). Mean PSA was
32.2 ng/ml (Median 23.0, IQR 10.5-31.5). Of the patients, 71.2% presented with >=cT3 disease. Biopsy Gleason score was >=8 in 23.1%. Of the patients, 18.1% had pT2 disease, 36.2% pT3a, 33.5% pT3b and 12.2 pT4. Final Gleason score
was =<6 in 37.6%, 7 in 32.8% and >=8 in 29.6%. Nodal status was N0 in 73.9%, 17.5% had 1-2 positive nodes and 8.6% had >=3 positive nodes. Positive surgical margins were present in 50.3%. Adjuvant radiotherapy and hormonal therapy were
administered in 12.6% and 66.2% respectively. Mean follow up was months 65.2 (Median 59, IQR 31-95). Using Kaplan-Meier analysis, estimated 10-year CSSrates for N0, 1-2 positive nodes and >= 3positive nodes were 92%, 77.2% and
74.6% respectively. Both cut-offs of 1-2 and >=3 positive nodes were significant predictors of worse CSS compared to the N0 group (both p<0.0001). However, in the Cox multivariable model, correcting for preoperative PSA, pTNM, final Gleason score and surgical margin status, only >=3 positive nodes was retained as an independent predictor of worse CSS (HR 2.17, 95% CI 1.011-4.701), while 1-2 positive nodes was not correlated with worse CSS (HR 1.70, 95% CI 0.883-3.280).

Conclusions: Patients with high risk PCa who have >=3 affected lymph nodes at surgery have a more than 2-fold increased risk of CSS, while those with 1-2 affected lymph nodes had comparable CSS compared to those who were N0.
These findings warrant a revision of the AJCC-TNM staging system.
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Urology Section (-)
Clinical Residents Medicine
# (joint) last author

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