Pelvic lymph node dissection and its extent on survival benefit in prostate cancer patients with a risk of lymph node invasion&gt;5%: A propensity score matching analysis from SEER database

Chen, J.; Wang, Zhoufeng; Zhao, Jinge; Zhu, Sha; Sun, Guangxi; Liu, J.; Zhang, H.; Zhang, X.; Shen, Pengfei; Zeng, Hao

doi:10.1093/annonc/mdz248.023

Cited by 7 publications

(16 citation statements)

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“…Nocera et al reported that 43% of low risk patients, 75% of intermediate risk patients, and 88% of high risk patients receive PLND (18). Similarly, an analysis by Chen et al found that 79% of patients with a greater than 5% risk of nodal involvement (a composite of intermediate and high risk patients) were receiving PLND with radical prostatectomy (19). Taken together, these suggest that utilization may potentially be slightly under-utilized in a small proportion of intermediate and high risk individuals, but equally importantly, potentially over-utilized in a larger proportion of low risk individuals (20).…”

Section: Indications: Guidelines and Real-world Utilizationmentioning

confidence: 99%

“…Nevertheless, despite the improved performance on staging and prognostication, no therapeutic benefit was garnered with similar rates of biochemical recurrence and increased complications. These findings are echoed in a recent systematic review of 66 studies by Fossati et al: no benefit was seen across biochemical recurrence, progression to distant metastases, cancer specific or overall survival with PLND; in a European multi-institutional retrospective study by Preisser et al demonstrating no difference in oncologic outcomes; and in a large propensitymatched SEER analysis in 2019 by Chen et al where neither those who received versus those who didn't receive PLND, nor the extent of PLND affected cancer specific or overall survival (1,19,48). Notably, many of these studies were confounded by substantial selection bias (in the case of the cohort studies) or with limited follow-up (in the clinical trials).…”

Section: Potential Oncologic Benefitsmentioning

confidence: 99%

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A narrative review of pelvic lymph node dissection in prostate cancer

Cheung¹,

Fleshner²,

Sengupta³

et al. 2020

Transl Androl Urol

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Pelvic lymph node dissection (PLND) is an important component in the staging and prognostication of prostate cancer. We performed a narrative review to assess the literature surrounding PLND: (I) the current guideline recommendations and contemporary utilization, (II) the calculation of patient-specific risk to perform PLND using available nomograms, (III) to review the extent of dissection, and its associated outcomes and complications. Due to the improved lymph node yield, better staging, and theoretical improvement in the control of micro-metastatic disease, guidelines have supported the use of (extended-) PLND in patients deemed to be at intermediate or high risk of lymph node involvement (often at a threshold of 5% on modern risk nomograms). However, in practice, real-world utilization of PLND varies considerably due to multiple reasons. Conflicting evidence persists with no clear oncological benefit to PLND, and a small, but important, risk of morbidity. Complications are rare, but include lymphoceles; thromboembolic events; and more rarely, obturator nerve, vascular, and ureteric injury. Furthermore, changing disease incidence and stage migration in the context of earlier detection overall have led to a decreased risk of nodal disease. The trade-offs between the benefits, harms, and risk tolerance/threshold must be carefully considered between each patient and their clinician.

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Section: Indications: Guidelines and Real-world Utilizationmentioning

confidence: 99%

Section: Potential Oncologic Benefitsmentioning

confidence: 99%

A narrative review of pelvic lymph node dissection in prostate cancer

Cheung¹,

Fleshner²,

Sengupta³

et al. 2020

Transl Androl Urol

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“…27 Moreover, with ePLND it is still not possible to determine and examine all positive lymph nodes, and remaining unremoved positive nodes can cause recurrence and progression. 9 Mattei et al 28 reported that with an ePLND, only 63% of all primary prostatic lymphatic landing sites can be resected. In addition, Joniau et al 29 found that 13% of the patients with LN+ can be missed by a standard ePLND.…”

Section: Discussionmentioning

confidence: 99%

Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate‐risk prostate cancer patients: A multicenter study of the Turkish Uro‐oncology Association

İzol

Aslan

et al. 2022

The Prostate

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Background Pelvic lymph node dissection (PLND) is the gold standard method for lymph node staging in prostate cancer. We aimed to evaluate the effect of PLND combined with radical prostatectomy (RP) on oncological outcomes in D'Amico intermediate‐risk prostate cancer (IRPC) patients. Methods Patients with D'Amico IRPC were included in the study. In the overall cohort and subgroups (biopsy International Society of Urological Pathology [ISUP] grade group 2 and 3), patients were divided into two groups as PLND and no‐PLND. More extensive PLND, defined as a number of removed nodes (NRN) ≥ 75th percentile. Results After exclusion, a total of 631 patients were included: 351 (55.6%) had PLND and 280 (44.4%) had no‐PLND. The mean age was 63.1 ± 3.60 years. The median NRN was 8.0 (1.0–40.0). The mean follow‐up period was 47.7 ± 37.5 months. The lymph node involvement (LNI) rate was 5.7% in the overall cohort, 3.9% in ISUP grade 2, and 10.8% in ISUP grade 3. Patients with PLND were associated with more aggressive clinicopathologic characteristics but no significant difference in biochemical recurrence‐free survival (BCRFS) was found between patients with PLND and no‐PLND (p = 0.642). In the subgroup analysis for ISUP grades 2 and 3, no significant difference in BCRFS outcomes was found in patients with PLND and No‐PLND (p = 0.680 and p = 0.922). Also, PLND extent had no effect on BCRFS (p = 0.569). The multivariable Cox regression model adjusted for preoperative tumor characteristics revealed that prostate specific antigen (PSA) (HR: 1.18, 95% CI: 1.01–1.25; p = 0.048) was an independent predictor of biochemical recurrence (BCR). The optimum cut‐off value for PSA, which can predict BCRFS, was assigned to be 7.81 ng/ml, with an AUC of 0.63 (95% CI: 0.571–0.688). The highest sensitivity and specificity were 0.667 and 0.549. Conclusion Overall and cancer‐specific survival analyzes were not evaluated because not enough events were observed. Neither PLND nor its extent improved BCRFS outcomes in IRPC. The LNI rate is low in patients with biopsy ISUP grade 2 and the BCR rate is low in those with PSA < 7.81 ng/dl so PLND can be omitted in these IRPC patients.

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“…PLND during radical prostatectomy (RP) remains the optimal method for nodal staging 3 . Extended PLND (ePLND) enhances the accuracy of surgical staging and may have potential therapeutic benefits in patients with both positive and negative nodes 4,5 . Surprisingly, however, a systematic review showed no clear survival benefit of PLND during RP 1 .…”

Section: Introductionmentioning

confidence: 99%

Predictive ability of prebiopsy magnetic resonance imaging and biopsy for side‐specific negative lymph node metastasis at radical prostatectomy

et al. 2022

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Background: Prostate cancer localization is reportedly associated with the laterality of lymph node metastasis. Thus, it may be feasible to predict side-specific lymph node metastasis (LNM) at radical prostatectomy (RP). To investigate whether multiparametric magnetic resonance imaging and biopsy findings can predict side-specific negative LNM and to explore the feasibility of unilateral lymph node dissection (LND) at RP. Methods: A total of 500 patients who were diagnosed with prostate cancer with prebiopsy multiparametric magnetic resonance imaging of the prostate and subsequent prostate biopsy and who underwent RP and extended LND without neoadjuvant treatment were enrolled. Multiparametric magnetic resonance imaging, biopsy findings, and LNM were assessed for each side. The negative predictive value (NPV) of multiparametric magnetic resonance imaging or biopsy or both for ipsilateral LNM was examined.Results: LNM was found in 9.2% (46/500) and 15.6% (28/180) of patients in the overall and high-risk cohorts, respectively. Magnetic resonance imaging and biopsy findings were negative in 408 and 262 sides, respectively, in the overall cohort and 144 and 100 sides, respectively, in the high-risk cohort. The NPVs of magnetic resonance imaging, biopsy, and both for ipsilateral LNM were 98.3%, 98.5%, and 99.1%, respectively, in the overall cohort, and 95.8%, 97.1%, and 97.6%, respectively, in the high-risk cohort.Conclusions: Unilateral LND may be indicated based on side-specific LNM risk as assessed by prebiopsy multiparametric magnetic resonance imaging and biopsy.

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Pelvic lymph node dissection and its extent on survival benefit in prostate cancer patients with a risk of lymph node invasion>5%: A propensity score matching analysis from SEER database

Cited by 7 publications

References 0 publications

A narrative review of pelvic lymph node dissection in prostate cancer

A narrative review of pelvic lymph node dissection in prostate cancer

Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate‐risk prostate cancer patients: A multicenter study of the Turkish Uro‐oncology Association

Predictive ability of prebiopsy magnetic resonance imaging and biopsy for side‐specific negative lymph node metastasis at radical prostatectomy

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