Marco Moschini1, Alberto Briganti2, Christopher R Murphy3, Marco Bianchi2, Giorgio Gandaglia2, Francesco Montorsi2, J Fernando Quevedo4, Rachel Carlson5, Eugene Kwon3, R Jeffrey Karnes6. 1. Department of Urology, Mayo Clinic, Rochester, MN, USA; Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. 2. Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy. 3. Department of Urology, Mayo Clinic, Rochester, MN, USA. 4. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA. 5. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 6. Department of Urology, Mayo Clinic, Rochester, MN, USA. Electronic address: karnes.r@mayo.edu.
Abstract
UNLABELLED: Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17%) had cN+; the 252 (83%) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p=0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p=0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p=0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. PATIENT SUMMARY: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent.
UNLABELLED: Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17%) had cN+; the 252 (83%) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p=0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p=0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p=0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. PATIENT SUMMARY: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent.
Authors: Thomas L Jang; Neal Patel; Izak Faiena; Kushan D Radadia; Dirk F Moore; Sammy E Elsamra; Eric A Singer; Mark N Stein; James A Eastham; Peter T Scardino; Yong Lin; Isaac Y Kim; Grace L Lu-Yao Journal: Cancer Date: 2018-09-25 Impact factor: 6.860
Authors: Bertram E Yuh; Young Suk Kwon; Brian M Shinder; Eric A Singer; Thomas L Jang; Sinae Kim; Mark N Stein; Tina Mayer; Anna Ferrari; Nara Lee; Rahul R Parikh; Nora Ruel; Wun-Jae Kim; Shigeo Horie; Seok-Soo Byun; Thomas E Ahlering; Isaac Yi Kim Journal: Prostate Int Date: 2018-10-25