Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer
- 1 July 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Journal of Clinical Oncology
- Vol. 25 (7), 1398-1404
- https://doi.org/10.1007/s10147-020-01682-1
Abstract
Background We investigated prognostic factors for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node (LN) dissection. Methods We included 173 patients who underwent RARP with extended pelvic LN dissection without neoadjuvant therapy at our hospital between October 2010 and April 2018. BCR was defined as prostate serum antigen (PSA) levels >= 0.2 ng/mL; BCR-free survival rates were determined using Kaplan-Meier analysis. We used Cox regression analysis to evaluate effects of PSA and pathologic variables on BCR. Results Median follow-up was 27.9 (range 6.1-86.9) months. Five-year BCR-free survival was 89.5%. In multivariate analysis, positive LNs (HR 7.117; 95% CI 2.826-17.925; P < 0.001) and Gleason score (GS) >= 8 (HR 2.612; 95% CI 1.051-6.489; P = 0.039) were significant predictors of BCR. Patients with 1 or 2 positive LNs (n = 10) had significantly higher BCR-free survival rates than patients with >= 3 positive LNs (n = 5). We, therefore, stratified the patients as low-risk (GS < 8 and no positive LNs), intermediate-risk: (either GS >= 8 or positive LNs) and high-risk (both GS >= 8 and positive LNs). Their 1-year BCR-free survival rates were low-risk: 94.6%, intermediate-risk: 88.5%, and high-risk: 33.3% (P < 0.05). Conclusions Patients with 1-2 positive LNs and GS < 8 have low risk for BCR; close observation without immediate adjuvant hormonal therapy can be considered for these patients.This publication has 32 references indexed in Scilit:
- Systematic Review and Meta-analysis of Studies Reporting Oncologic Outcome After Robot-assisted Radical ProstatectomyEuropean Urology, 2012
- Lymph node count threshold for optimal pelvic lymph node staging in prostate cancerInternational Journal of Urology, 2012
- EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Treatment of Clinically Localised DiseaseEuropean Urology, 2011
- Pelvic Lymph Node Dissection in Prostate CancerEuropean Urology, 2009
- Two Positive Nodes Represent a Significant Cut-off Value for Cancer Specific Survival in Patients with Node Positive Prostate Cancer. A New Proposal Based on a Two-Institution Experience on 703 Consecutive N+ Patients Treated with Radical Prostatectomy, Extended Pelvic Lymph Node Dissection and Adjuvant TherapyEuropean Urology, 2009
- Good Outcome for Patients with Few Lymph Node Metastases After Radical Retropubic ProstatectomyEuropean Urology, 2008
- The Template of the Primary Lymphatic Landing Sites of the Prostate Should Be Revisited: Results of a Multimodality Mapping StudyEuropean Urology, 2008
- Long-Term Outcome After Radical Prostatectomy for Patients With Lymph Node Positive Prostate Cancer in the Prostate Specific Antigen EraJournal of Urology, 2007
- The Association Between Total and Positive Lymph Node Counts, and Disease Progression in Clinically Localized Prostate CancerJournal of Urology, 2006
- Disease Progression and Survival of Patients With Positive Lymph Nodes After Radical Prostatectomy. Is there a Chance of Cure?Journal of Urology, 2003