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Is More Always Better? An Assessment of the Impact of Lymph Node Yield on Outcome for Clinically Localized Prostate Cancer with Low/Intermediate Risk Pathology (pT2-3a/pN0) Managed with Prostatectomy Alone.

Authors
  • Seyedin, Steven N1
  • Mitchell, Darrion L2
  • Mott, Sarah L3
  • Russo, J Kyle4
  • Tracy, Chad R5
  • Snow, Anthony N6
  • Parkhurst, Jessica R1
  • Smith, Mark C1
  • Buatti, John M1
  • Watkins, John M7
  • 1 Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
  • 2 Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA.
  • 3 Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
  • 4 Bismarck Cancer Center, Bismarck, ND, USA.
  • 5 Department of Urology, University of Iowa, Iowa City, IA, USA.
  • 6 Department of Pathology, University of Iowa, Iowa City, IA, USA.
  • 7 Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA. [email protected]
Type
Published Article
Journal
Pathology & Oncology Research
Publisher
Springer-Verlag
Publication Date
Oct 27, 2017
Identifiers
DOI: 10.1007/s12253-017-0349-5
PMID: 29079967
Source
Medline
Keywords
License
Unknown

Abstract

The clinical impact of lymph node dissection extent remains undetermined in the contemporary setting, as reflected in care pattern variations. Despite some series demonstrating a direct relationship between number of lymph nodes identified and detection of nodal involvement, the correlation between lymph node yield and disease control or survival outcomes remains unclear. Patients with clinically localized prostate cancer, pre-RP PSA <30, and pT2-3a/N0 disease at RP were retrospectively identified from two databases for inclusion. Those who received pre- or post-RP radiotherapy or hormone therapy were excluded. Kaplan-Meier method was employed for survival probability estimation. Cox regression models were used to assess bRFS differences between subsets. From 2002 to 2010, 667 eligible patients were identified. The median age was 61 yrs. (range, 43-76), with median PSA 5.6 ng/dL (0.9-28.0). At RP, most patients had pT2c (64%) disease with Gleason Score (GS) ≤6 (43%) or 7 (48%); 218 (33%) patients had positive margins (M+). At median clinical and PSA follow-up of 96 and 87 months, respectively, 146 patients (22%) experienced PSA failure with an estimated bRFS of 81%/76% at 5/8 years. For patients who underwent LND, univariable analysis identified PSA (at diagnosis), higher GS (≥7, at biopsy or RP), intermediate/high risk stratification, M+ as adversely associated with bRFS (all p < 0.01). A higher number of LNs excised was not associated with improved bRFS for the entire cohort (HR = 0.97, p = 0.27), nor for any clinical risk stratum, biopsy GS, or RP GS subgroup. This study did not demonstrate an association between LN yield and bRFS in patients with clinically localized pT2-3a/pN0 prostate cancer managed with RP alone, either in the entire population or with substratification by clinical risk stratum or GS.

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