OBJECTIVE: To assess the prognostic role of extranodal extension (ENE) and the size of the largest lymph node (LN) metastasis in predicting early biochemical relapse (eBCR) in patients with LN metastasis after radical prostatectomy (RP).
METHODS AND MATERIALS: We evaluated BCR-free survival in men with LN metastases after RP and pelvic LN dissection performed in six high volume centers. Multivariable Cox regression tested the role of ENE and diameter of largest LN metastasis in predicting eBCR after adjusting for clinco-pathological variables. We compared the discrimination of multivariable models including ENE, the size of largest LN metastasis and the number of positive LNs.
RESULTS: Overall, 484 patients were included. Median follow-up was 16.1 months (IQR 6-27.5). Median number of removed LNs was 10 (IQR 4-14), and median number of positive LNs was 1 (IQR: 1-2). ENE was present in 280 (58%) patients, and 211 (44%) had their largest metastasis >10mm. Patients with ENE and/or largest metastasis >10mm had significantly worse eBCR-free survival (all p< 0.01). On multivariable analysis, number of positive LNs (≤ 2 vs >2) and the diameter of LN metastasis (≤ 10 vs >10mm), but not ENE, were significant predictors of eBCR (all p< 0.003). ENE and diameter of LN metastasis increased the AUC of a baseline multivariable model (0.663) by 0.016 points.
CONCLUSIONS: The diameter of the largest LN metastasis and the number of positive LNs are independent predictors of eBCR. Considered together, ENE and the diameter of the largest LN metastasis have less discrimination than the number of positive LNs.
Written by:
Passoni NM, Fajkovic H, Xylinas E, Kluth L, Seitz C, Robinson BD, Rouprêt M, Chun FK, Lotan Y, Roehrborn CG, Crivelli JJ, Karakiewicz PI, Scherr DS, Rink M, Graefen M, Schramek P, Briganti A, Montorsi F, Tewari A, Shariat SF. Are you the author?
Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.
Reference: BJU Int. 2013 Jul 2. Epub ahead of print.
doi: 10.1111/bju.12342
PubMed Abstract
PMID: 24053552
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