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

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.

The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Risk Prostate Cancer: A Population-Based Study

“…One recent study showed that ePLND and lymph node yield were found no statistical link to BCR in patients with intermediate-risk PCa. However, some scholars reported that higher lymph node yield was associated with biochemical free recurrence survival mainly because of identi cation of an increased number of positive LNs [19] . In fact, due to the heterogeneity of intermediaterisk PCa, more work needs to be done to further characterize patients within this group and identify the minority of patients with a more favorable prognosis for which expectant treatments would be effective.…”

Der onkologische Nutzen der pelvinen Lymphadenektomie ist beim Prostatakarzinom nicht geklärt

“…"Is more always better? ", fragen die Autoren einer aktuellen Arbeit zur pLA [42]. Sie belegen, dass im Tumorstadium pT2-3a, pN0 unter Verzicht auf weitere Behandlungen (Hormone, Bestrahlung) die Zahl der entfernten LK das biochemische Rezidiv nicht beeinflusst; entscheidend hierfür sind Gleason-Score, positiver Schnittrand und ein höheres Risikostratum nach D'Amico.…”

Der onkologische Nutzen der pelvinen Lymphadenektomie ist beim Prostatakarzinom nicht geklärt

“…"Is More Always Better?" fragen die Autoren einer aktuellen Arbeit zur pLA [42]. Sie belegen, dass im Tumorstadium pT2-3a, pN0 unter Verzicht auf weitere Behandlungen (Hormone, Bestrahlung) die Zahl der entfernten LK das biochemische Rezidiv nicht beeinflusst; entscheidend hierfür sind Gleason-Score, positiver Schnittrand und eine höheres Risikostratum nach D'Amico.…”