OBJECTIVES: To determine if the number of lymph nodes (LNs) removed is an independent predictor of biochemical recurrence (BCR) in patients without LN metastases undergoing radical prostatectomy (RP).
MATERIAL AND METHODS: Retrospective analysis of 7,310 patients treated at 7 centers with RP and pelvic LN dissection for clinically localized prostate cancer between 2000 and 2011. Patients with LN metastases (n = 398) and other reasons (stated later in the article) (n = 372) were excluded, which left 6,540 patients for the final analyses.
RESULTS: Overall, median biopsy and RP Gleason score were both 7; median prostate specific antigen level was 6ng/ml (interquartile range [IQR]: 5); and median number of LNs removed was 6 (IQR: 8). A total of 3,698 (57%), 2,064 (32%), and 508 (8%) patients had ≥6, ≥10, and ≥20 LNs removed, respectively. Patients with more LNs removed were older, had a higher prostate specific antigen level, had higher clinical and pathologic T stage, and had higher RP Gleason score (all P< 0.002). Within a median follow-up of 21 (IQR: 16) months, more LNs removed was associated with an increased risk of BCR (continuous: P = 0.021; categorical: P = 0.014). In multivariable analyses that adjusted for the effects of standard clinicopathologic factors, none of the nodal stratifications predicted BCR.
CONCLUSIONS: The number of LNs did not have any prognostic significance in our contemporary cohort of patients with LN-negative prostate cancer. This suggests that the risk of missed clinically significant micrometastasis may be minimal in patients currently treated with RP and having a lower LN yield.
Written by:
Kluth LA, Xylinas E, Rieken M, Chun FK, Fajkovic H, Becker A, Karakiewicz PI, Passoni N, Herman M, Lotan Y, Seitz C, Schramek P, Remzi M, Loidl W, Guillonneau B, Rouprêt M, Briganti A, Scherr DS, Graefen M, Tewari AK, Shariat SF. Are you the author?
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
Reference: Urol Oncol. 2013 Sep 18. pii: S1078-1439(13)00283-4.
doi: 10.1016/j.urolonc.2013.06.013
PubMed Abstract
PMID: 24055425
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