Luis A Kluth1, Evanguelos Xylinas2, Malte Rieken3, Felix K-H Chun4, Harun Fajkovic5, Andreas Becker6, Pierre I Karakiewicz7, Niccolo Passoni8, Michael Herman9, Yair Lotan10, Christian Seitz11, Paul Schramek11, Mesut Remzi12, Wolfgang Loidl13, Bertrand Guillonneau14, Morgan Rouprêt15, Alberto Briganti8, Douglas S Scherr9, Markus Graefen16, Ashutosh K Tewari9, Shahrokh F Shariat17. 1. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France. 3. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Hospital of Basel, Basel, Switzerland. 4. Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Urology, Landesklinikum St.Poelten, Sankt Poelten, Austria. 6. Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 7. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 8. Department of Urology, Vita-Salute University, Milan, Italy. 9. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY. 10. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. 11. Department of Urology, Medical University of Vienna, Vienna, Austria. 12. Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria. 13. Prostate cancer center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria. 14. Department of Urology, Diaconesses Hospital, Paris 6 University, Paris, France. 15. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médicine Pierre et Marie Curie, Paris, France. 16. Prostate cancer center, Martini-Clinic, Hamburg, Germany. 17. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
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.
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.
Authors: Steven N Seyedin; Darrion L Mitchell; Sarah L Mott; J Kyle Russo; Chad R Tracy; Anthony N Snow; Jessica R Parkhurst; Mark C Smith; John M Buatti; John M Watkins Journal: Pathol Oncol Res Date: 2017-10-27 Impact factor: 3.201
Authors: Katharina Beyer; Lisa Moris; Michael Lardas; Anna Haire; Francesco Barletta; Simone Scuderi; Megan Molnar; Ronald Herrera; Abdul Rauf; Riccardo Campi; Isabella Greco; Kirill Shiranov; Saeed Dabestani; Thomas van den Broeck; Sujenthiran Arun; Mauro Gacci; Giorgio Gandaglia; Muhammad Imran Omar; Steven MacLennan; Monique J Roobol; Bahman Farahmand; Eleni Vradi; Zsuzsanna Devecseri; Alex Asiimwe; Jihong Zong; Sara J Maclennan; Laurence Collette; James NDow; Alberto Briganti; Anders Bjartell; Mieke Van Hemelrijck Journal: BMJ Open Date: 2022-04-04 Impact factor: 2.692