Title: In high-risk prostate cancer, the number of lymph nodes removed at radical prostatectomy does not affect the risk of cancer related death or death from any cause
Authors: Joniau, Steven
Van Baelen, Anthony
Spahn, M
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
Gontero, P #
Issue Date: Mar-2011
Publisher: Elsevier science bv
Host Document: European urology supplements vol:10 issue:2 pages:185-186
Conference: Annual EAU Congress edition:26 location:Vienna date:18-22 March 2011
Article number: 563
Abstract: Introduction & Objectives: Nodal metastases (N+) at the time of radical
prostatectomy (RP) and pelvic lymph node dissection (PLND) portend a poor
prognosis. It is also common knowledge that the number of positive lymph nodes
found, is strongly related to the number of nodes resected. However, it remains
unclear whether the number of nodes resected directly influences cancer-specific
(CSS) and overall survival (OS). We aimed to determine the impact of the total
number of nodes removed on OS and CSS after RP and PLND in high-risk prostate
cancer patients.
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.
For statistical analysis, the total numbers of nodes removed were grouped as
follows: 1-5 vs. 6-10 vs. 11-15 vs. 16+. The impact of the total number of lymph
nodes removed on OS and CSS survival was evaluated using multivariate Cox
proportional-hazards regression models.
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 N+ in
26.1%. 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). Of the patients, 22.6% had
1 to 5 nodes removed, 42.8% had 6 to 10 nodes removed, 25.1% had 11 to 15
nodes removed and 9.5% had 16+ nodes removed. In the Cox multivariable
models, correcting for preoperative PSA, pTNM, final Gleason score, lymph node
invasion, surgical margin status and age (only for OS), neither cut-off of number of
lymph nodes removed was an independent predictor of CSS and OS (all p>0.05).
Surgical margin status and pT3b-pT4 were independent predictors of CSS, while
lymph node invasion and final Gleason score >=8 were independent predictors of
both CSS and OS.
Conclusions: In high-risk prostate cancer patients, the number of lymph nodes
removed is not a significant predictor of cancer-specific or overall survival.
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Urology Section (-)
# (joint) last author

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