Mike Wenzel1,2, Christoph Würnschimmel2,3, Luigi Nocera2,4, Claudia Collà Ruvolo2,5, Zhe Tian2, Shahrokh F Shariat6,7,8,9,10,11, Fred Saad2, Alberto Briganti4, Markus Graefen3, Luis A Kluth1, Philipp Mandel1, Felix K H Chun1, Pierre I Karakiewicz2. 1. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany. 2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. 3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy. 6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 7. Departments of Urology, Weill Cornell Medical College, New York, New York, USA. 8. Department of Urology, University of Texas Southwestern, Dallas, Texas, USA. 9. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic. 10. Department of Urology, Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Abstract
BACKGROUND: We hypothesized that lymph node dissection (LND) at salvage radical prostatectomy may be associated with lower cancer-specific mortality (CSM) and we tested this hypothesis. METHODS: We relied on surveillance, epidemiology, and end results (2004-2016) to identify all salvage radical prostatectomy patients. Categorical, as well as univariate and multivariate Cox regression models tested the effect of LND (LND performed vs. not), as well as at its extent (log-transformed lymph node count) on CSM. RESULTS: Of 427 salvage radical prostatectomy patients, 120 (28.1%) underwent LND with a median lymph node count of 6 (interquartile range [IQR], 3-11). According to LND status, no significant or clinically meaningful differences were recorded in PSA at diagnosis, stage and biopsy Gleason score at diagnosis, except for age at prostate cancer diagnosis (LND performed 63 vs. 68 years LND not performed, p < .001). LND status (performed) was an independent predictor of lower CSM (hazard ratio [HR] 0.47; p = .03). Similarly, lymph node count (log transformed) also independently predicted lower CSM (HR: 0.60; p = .01). After the 7th removed lymph node, the effect of CSM became marginal. The effect of N-stage on CSM could not be tested due to insufficient number of observations. CONCLUSIONS: Salvage radical prostatectomy is rarely performed and LND at salvage radical prostatectomy is performed in a minority of patients. However, LND at salvage radical prostatectomy is associated with lower CSM. Moreover, LND extent also exerts a protective effect on CSM. These observations should be considered in salvage radical prostatectomy candidates.
BACKGROUND: We hypothesized that lymph node dissection (LND) at salvage radical prostatectomy may be associated with lower cancer-specific mortality (CSM) and we tested this hypothesis. METHODS: We relied on surveillance, epidemiology, and end results (2004-2016) to identify all salvage radical prostatectomy patients. Categorical, as well as univariate and multivariate Cox regression models tested the effect of LND (LND performed vs. not), as well as at its extent (log-transformed lymph node count) on CSM. RESULTS: Of 427 salvage radical prostatectomy patients, 120 (28.1%) underwent LND with a median lymph node count of 6 (interquartile range [IQR], 3-11). According to LND status, no significant or clinically meaningful differences were recorded in PSA at diagnosis, stage and biopsy Gleason score at diagnosis, except for age at prostate cancer diagnosis (LND performed 63 vs. 68 years LND not performed, p < .001). LND status (performed) was an independent predictor of lower CSM (hazard ratio [HR] 0.47; p = .03). Similarly, lymph node count (log transformed) also independently predicted lower CSM (HR: 0.60; p = .01). After the 7th removed lymph node, the effect of CSM became marginal. The effect of N-stage on CSM could not be tested due to insufficient number of observations. CONCLUSIONS: Salvage radical prostatectomy is rarely performed and LND at salvage radical prostatectomy is performed in a minority of patients. However, LND at salvage radical prostatectomy is associated with lower CSM. Moreover, LND extent also exerts a protective effect on CSM. These observations should be considered in salvage radical prostatectomy candidates.
Authors: Mike Wenzel; Luigi Nocera; Christoph Würnschimmel; Claudia Collà Ruvolo; Zhe Tian; Fred Saad; Alberto Briganti; Derya Tilki; Markus Graefen; Andreas Becker; Frederik C Roos; Felix K H Chun; Pierre I Karakiewicz Journal: Front Oncol Date: 2021-10-06 Impact factor: 6.244
Authors: Mike Wenzel; Christoph Würnschimmel; Luigi Nocera; Claudia Colla Ruvolo; Benedikt Hoeh; Zhe Tian; Shahrokh F Shariat; Fred Saad; Alberto Briganti; Markus Graefen; Felix Preisser; Andreas Becker; Philipp Mandel; Felix K H Chun; Pierre I Karakiewicz Journal: Front Oncol Date: 2022-08-19 Impact factor: 5.738
Authors: Fahad Quhal; Pawel Rajwa; Keiichiro Mori; Ekaterina Laukhtina; Nico C Grossmann; Victor M Schuettfort; Frederik König; Abdulmajeed Aydh; Reza S Motlagh; Satoshi Katayama; Hadi Mostafai; Benjamin Pradere; Giancarlo Marra; Paolo Gontero; Romain Mathieu; Pierre I Karakiewicz; Alberto Briganti; Shahrokh F Shariat; Axel Heidenreich Journal: Prostate Date: 2021-05-31 Impact factor: 4.104
Authors: Mike Wenzel; Felix Preisser; Benedikt Hoeh; Maria N Welte; Clara Humke; Clarissa Wittler; Christoph Würnschimmel; Andreas Becker; Pierre I Karakiewicz; Felix K H Chun; Philipp Mandel; Luis A Kluth Journal: Front Surg Date: 2021-12-09