Marco Moschini1, Vidit Sharma1, Fabio Zattoni1, J Fernando Quevedo2, Brian J Davis3, Eugene Kwon1, R Jeffrey Karnes4. 1. Department of Urology, Mayo Clinic, Rochester, MN, USA. 2. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA. 3. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. 4. Department of Urology, Mayo Clinic, Rochester, MN, USA. Electronic address: Karnes.R@mayo.edu.
Abstract
BACKGROUND: Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature. OBJECTIVE: To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS: Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM). RESULTS AND LIMITATIONS: Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31-35%) for all patients and 52.2% (95% CI, 47.3-57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n=94, 55%), nodal (n=59, 34%), local soft tissue (n=29, 17%), and visceral (n=8, 5%). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p<0.05). CONCLUSIONS: Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions. PATIENT SUMMARY: We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy.
BACKGROUND:Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature. OBJECTIVE: To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS: Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM). RESULTS AND LIMITATIONS: Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31-35%) for all patients and 52.2% (95% CI, 47.3-57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n=94, 55%), nodal (n=59, 34%), local soft tissue (n=29, 17%), and visceral (n=8, 5%). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p<0.05). CONCLUSIONS: Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions. PATIENT SUMMARY: We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy.
Authors: Andrea K Miyahira; Joshua M Lang; Robert B Den; Isla P Garraway; Tamara L Lotan; Ashley E Ross; Tanya Stoyanova; Steve Y Cho; Jonathan W Simons; Kenneth J Pienta; Howard R Soule Journal: Prostate Date: 2015-10-19 Impact factor: 4.104
Authors: Maria Vinsensia; Peter L Chyoke; Boris Hadaschik; Tim Holland-Letz; Jan Moltz; Klaus Kopka; Isabel Rauscher; Walter Mier; Markus Schwaiger; Uwe Haberkorn; Tobias Mauer; Clemens Kratochwil; Matthias Eiber; Frederik L Giesel Journal: J Nucl Med Date: 2017-06-21 Impact factor: 10.057
Authors: Philipp Mandel; Clemens Rosenbaum; Raisa S Pompe; Thomas Steuber; Georg Salomon; Felix K Chun; Markus Graefen; Hartwig Huland; Derya Tilki Journal: World J Urol Date: 2017-08-21 Impact factor: 4.226
Authors: Michael C Haffner; Wilbert Zwart; Martine P Roudier; Lawrence D True; William G Nelson; Jonathan I Epstein; Angelo M De Marzo; Peter S Nelson; Srinivasan Yegnasubramanian Journal: Nat Rev Urol Date: 2020-12-16 Impact factor: 14.432
Authors: M Moschini; N Fossati; F Abdollah; G Gandaglia; V Cucchiara; P Dell'Oglio; S Luzzago; S F Shariat; F Dehò; A Salonia; F Montorsi; A Briganti Journal: Prostate Cancer Prostatic Dis Date: 2015-11-10 Impact factor: 5.554
Authors: Dae Keun Kim; Kyo Chul Koo; Ali Abdel Raheem; Ki Hong Kim; Byung Ha Chung; Young Deuk Choi; Koon Ho Rha Journal: PLoS One Date: 2016-03-31 Impact factor: 3.240
Authors: Stefano Mangiola; Matthew K H Hong; Marek Cmero; Natalie Kurganovs; Andrew Ryan; Anthony J Costello; Niall M Corcoran; Geoff Macintyre; Christopher M Hovens Journal: Sci Rep Date: 2016-09-22 Impact factor: 4.379