Does increasing the nodal yield improve outcomes in contemporary patients without nodal metastasis undergoing radical prostatectomy?

Luis A Kluth, Evanguelos Xylinas, Malte Rieken, Felix K-H Chun, Harun Fajkovic, Andreas Becker, Pierre I Karakiewicz, Niccolo Passoni, Michael Herman, Yair Lotan, Christian Seitz, Paul Schramek, Mesut Remzi, Wolfgang Loidl, Bertrand Guillonneau, Morgan Rouprêt, Alberto Briganti, Douglas S Scherr, Markus Graefen, Ashutosh K TewariShahrokh F Shariat

Research output: Journal article (peer-reviewed)Journal article

7 Citations (Scopus)

Abstract

OBJECTIVES: To determine if the number of lymph nodes (LNs) removed is an independent predictor of biochemical recurrence (BCR) in patients without LN metastases undergoing radical prostatectomy (RP).

MATERIAL AND METHODS: Retrospective analysis of 7,310 patients treated at 7 centers with RP and pelvic LN dissection for clinically localized prostate cancer between 2000 and 2011. Patients with LN metastases (n = 398) and other reasons (stated later in the article) (n = 372) were excluded, which left 6,540 patients for the final analyses.

RESULTS: Overall, median biopsy and RP Gleason score were both 7; median prostate specific antigen level was 6 ng/ml (interquartile range [IQR]: 5); and median number of LNs removed was 6 (IQR: 8). A total of 3,698 (57%), 2,064 (32%), and 508 (8%) patients had ≥ 6, ≥ 10, and ≥ 20 LNs removed, respectively. Patients with more LNs removed were older, had a higher prostate specific antigen level, had higher clinical and pathologic T stage, and had higher RP Gleason score (all P<0.002). Within a median follow-up of 21 (IQR: 16) months, more LNs removed was associated with an increased risk of BCR (continuous: P = 0.021; categorical: P = 0.014). In multivariable analyses that adjusted for the effects of standard clinicopathologic factors, none of the nodal stratifications predicted BCR.

CONCLUSIONS: The number of LNs did not have any prognostic significance in our contemporary cohort of patients with LN-negative prostate cancer. This suggests that the risk of missed clinically significant micrometastasis may be minimal in patients currently treated with RP and having a lower LN yield.

Original languageEnglish
Pages (from-to)47.e1-47.e8
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 2014

Keywords

  • Aged
  • Disease-Free Survival
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision
  • Lymph Nodes/pathology
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Prostate-Specific Antigen/blood
  • Prostatectomy/methods
  • Prostatic Neoplasms/blood
  • Retrospective Studies
  • Treatment Outcome
  • Biochemical recurrence
  • Lymph node metastasis
  • Nodal yield
  • Pelvic lymph node dissection
  • Prostate cancer

ASJC Scopus subject areas

  • Urology
  • Oncology

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