This study aimed to create a prognostic model to predict disease recurrence among patients with lymph node involvement but no prostate-specific antigen (PSA) persistence and to explore its clinical utility.
The study analyzed patients with lymph node involvement after pelvic lymph node dissection with radical prostatectomy in whom no PSA persistence was observed between 2006 and 2019 at 33 institutions. Prognostic factors for recurrence-free survival (RFS) were analyzed by the Cox proportional hazards model.
Among 231 patients, 127 experienced disease recurrence. The factors prognostic for RFS were PSA level at diagnosis (≥ 20 vs. < 20 ng/mL: hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.09-2.52; P = 0.017), International Society of Urological Pathology grade group at radical prostatectomy (RP) specimen (group ≥ 4 vs. ≤ 3: HR, 1.63; 95% CI 1.12-2.37; P = 0.010), pathologic T-stage (pT3b/4 vs. pT2/3a: HR, 1.70; 95% CI 1.20-2.42; P = 0.0031), and surgical margin status (positive vs. negative: HR, 1.60; 95% CI 1.13-2.28; P = 0.0086). The prognostic model using four parameters were associated with RFS and metastasis-free survival.
The prognostic model in combination with postoperative PSA value and number of lymph nodes is clinically useful for discussing treatment choice with patients.
Annals of surgical oncology. 2024 Feb 14 [Epub ahead of print]
Masaki Shiota, Dai Takamatsu, Yoshiyuki Matsui, Akira Yokomizo, Shuichi Morizane, Ryoichi Saito, Makito Miyake, Masakazu Tsutsumi, Yoshiyuki Yamamoto, Kojiro Tashiro, Ryotaro Tomida, Shintaro Narita, Kohei Edamura, Takahiro Yamaguchi, Kohei Hashimoto, Masashi Kato, Takashi Kasahara, Takayuki Yoshino, Shusuke Akamatsu, Tomoyuki Kaneko, Akihiro Matsukawa, Ryuji Matsumoto, Akira Joraku, Toshihiro Saito, Takuma Kato, Manabu Kato, Hideki Enokida, Shinichi Sakamoto, Naoki Terada, Hidenori Kanno, Naotaka Nishiyama, Takahiro Kimura, Hiroshi Kitamura, Masatoshi Eto, Japanese Urological Oncology Group
Department of Urology, Kyushu University, Fukuoka, Japan. ., Department of Urology, Kyushu University, Fukuoka, Japan., Department of Urology, National Cancer Center Hospital, Tokyo, Japan., Department of Urology, Harasanshin Hospital, Fukuoka, Japan., Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan., Department of Urology and Andrology, Kansai Medical University, Osaka, Japan., Department of Urology, Nara Medical University, Kashihara, Japan., Department of Urology, Hitachi General Hospital, Hitachi, Japan., Department of Urology, Osaka International Cancer Institute, Osaka, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Shikoku Cancer Center, Matsuyama, Japan., Department of Urology, Akita University, Akita, Japan., Department of Urology, Okayama University, Okayama, Japan., Department of Urology, Kumamoto University, Kumamoto, Japan., Department of Urology, Sapporo Medical University, Sapporo, Japan., Department of Urology, Nagoya University, Nagoya, Japan., Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University, Niigata, Japan., Department of Urology, University of Tsukuba, Tsukuba, Japan., Department of Urology, Kyoto University, Kyoto, Japan., Department of Urology, Teikyo University School of Medicine, Tokyo, Japan., Department of Urology, Kashiwa Hospital, The Jikei University, Chiba, Japan., Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan., Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan., Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan., Department of Urology, Kagawa University, Kagawa, Japan., Department of Nephro-Urologic Surgery and Andrology, Mie University, Tsu, Japan., Department of Urology, Kagoshima University, Kagoshima, Japan., Department of Urology, Chiba University, Chiba, Japan., Department of Urology, Miyazaki University, Miyazaki, Japan., Department of Urology, Yamagata University, Yamagata, Japan., Department of Urology, University of Toyama, Toyama, Japan.