BACKGROUND: The role of extended pelvic lymph node dissection (ePLND) in treating prostate cancer (PCa) patients with lymph node invasion (LNI) remains controversial. OBJECTIVE: The relationship between the number of removed lymph nodes (RLNs) and cancer-specific mortality (CSM) was tested in patients with LNI. DESIGN, SETTING, AND PARTICIPANTS: We examined data of 315 pN1 PCa patients treated with radical prostatectomy (RP) and anatomically ePLND between 2000 and 2012 at one tertiary care centre. All patients received adjuvant hormonal therapy with or without adjuvant radiotherapy (aRT). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable Cox regression analyses tested the relationship between RLN number and CSM rate, after adjusting to all available covariates. Survival estimates were based on the multivariable model; patients were stratified according to RLN number using points of maximum separation. RESULTS AND LIMITATIONS: The average number of RLNs was 20.8 (median: 19; interquartile range: 14-25). Mean and median follow-up were 63.1 and 54 mo, respectively. At 10-yr, the CSM-free survival rate was 74.7%, 85.9%, 92.4%, 96.0%, and 97.9% for patients with 8, 17, 26, 36, and 45 RLNs, respectively. By multivariable analyses, the number of RLNs independently predicted lower CSM rate (hazard ratio [HR]: 0.93; p=0.02). Other predictors of CSM were Gleason score 8-10 (HR: 3.3), number of positive nodes (HR: 1.2), and aRT treatment (HR: 0.26; all p ≤ 0.006). The study is limited by its retrospective nature. CONCLUSIONS: In PCa patients with LNI, the removal of a higher number of LNs during RP was associated with improvement in cancer-specific survival rate. This implies that ePLND should be considered in all patients with a significant preoperative risk of harbouring LNI. PATIENT SUMMARY: We found that removing more lymph nodes during prostate cancer surgery can significantly improve cancer-specific survival in patients with lymph node invasion.
BACKGROUND: The role of extended pelvic lymph node dissection (ePLND) in treating prostate cancer (PCa) patients with lymph node invasion (LNI) remains controversial. OBJECTIVE: The relationship between the number of removed lymph nodes (RLNs) and cancer-specific mortality (CSM) was tested in patients with LNI. DESIGN, SETTING, AND PARTICIPANTS: We examined data of 315 pN1 PCa patients treated with radical prostatectomy (RP) and anatomically ePLND between 2000 and 2012 at one tertiary care centre. All patients received adjuvant hormonal therapy with or without adjuvant radiotherapy (aRT). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable Cox regression analyses tested the relationship between RLN number and CSM rate, after adjusting to all available covariates. Survival estimates were based on the multivariable model; patients were stratified according to RLN number using points of maximum separation. RESULTS AND LIMITATIONS: The average number of RLNs was 20.8 (median: 19; interquartile range: 14-25). Mean and median follow-up were 63.1 and 54 mo, respectively. At 10-yr, the CSM-free survival rate was 74.7%, 85.9%, 92.4%, 96.0%, and 97.9% for patients with 8, 17, 26, 36, and 45 RLNs, respectively. By multivariable analyses, the number of RLNs independently predicted lower CSM rate (hazard ratio [HR]: 0.93; p=0.02). Other predictors of CSM were Gleason score 8-10 (HR: 3.3), number of positive nodes (HR: 1.2), and aRT treatment (HR: 0.26; all p ≤ 0.006). The study is limited by its retrospective nature. CONCLUSIONS: In PCa patients with LNI, the removal of a higher number of LNs during RP was associated with improvement in cancer-specific survival rate. This implies that ePLND should be considered in all patients with a significant preoperative risk of harbouring LNI. PATIENT SUMMARY: We found that removing more lymph nodes during prostate cancer surgery can significantly improve cancer-specific survival in patients with lymph node invasion.
Authors: Michael Mix; Kathrin Reichel; Christian Stoykow; Mark Bartholomä; Vanessa Drendel; Eleni Gourni; Ulrich Wetterauer; Wolfgang Schultze-Seemann; Philipp T Meyer; Cordula A Jilg Journal: Eur J Nucl Med Mol Imaging Date: 2018-07-30 Impact factor: 9.236
Authors: Nicola Fossati; Niccolò M Passoni; Marco Moschini; Giorgio Gandaglia; Alessandro Larcher; Massimo Freschi; Giorgio Guazzoni; Daniel D Sjoberg; Andrew J Vickers; Francesco Montorsi; Alberto Briganti Journal: BJU Int Date: 2015-06-10 Impact factor: 5.588
Authors: Filip Poelaert; Valérie Fonteyne; Piet Ost; Bart De Troyer; Karel Decaestecker; Gert De Meerleer; Pieter De Visschere; Tom Claeys; Bert Dhondt; Nicolaas Lumen Journal: Strahlenther Onkol Date: 2017-01-18 Impact factor: 3.621
Authors: Johannes Schwenck; Hansjoerg Rempp; Gerald Reischl; Stephan Kruck; Arnulf Stenzl; Konstantin Nikolaou; Christina Pfannenberg; Christian la Fougère Journal: Eur J Nucl Med Mol Imaging Date: 2016-08-24 Impact factor: 9.236
Authors: Nina Natascha Harke; Michael Godes; Christian Wagner; Mustapha Addali; Bernhard Fangmeyer; Katarina Urbanova; Boris Hadaschik; Jorn H Witt Journal: World J Urol Date: 2018-05-16 Impact factor: 4.226