Prognostic factors in lymph node metastases of prostatic cancer patients: the size of the metastases but not extranodal extension independently predicts survival

Fleischmann, Achim; Schobinger, Sylviane; Markwalder, Regula; Schumacher, Martin; Burkhard, Fiona C.; Thalmann, George N.; Studer, Urs E.

doi:10.1111/j.1365-2559.2008.03129.x

Cited by 42 publications

(63 citation statements)

References 35 publications

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“…While, the role of number of positive LN and lymph node density as prognostic factors is well accepted 2, 5-6 , data regarding extranodal extension (ENE), size of the positive LN and size of the metastatic focus within the LN remains controversial and understudied 1, 3, 7-8 .…”

Section: Introductionmentioning

confidence: 99%

Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate Cancer

et al. 2013

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Purpose Subclassification of nodal stage may be of prognostic value in men with lymph node metastases (LNM) at the time of radical prostatectomy (RP). We explored the role of extranodal extension (ENE), size of the largest metastatic LN, size of the largest metastasis and LN density (LND) as predictors of biochemical recurrence (BCR). Materials and Methods We reviewed pathological material from 261 node-positive prostate cancer patients. We examined the predictive value when adding the additional pathology findings to a base model including extraprostatic extension (EPE), seminal vesicle invasion (SVI), RP Gleason score, Prostate-Specific Antigen (PSA) and number of positive LNs, using Cox proportional hazards regression and Harrell's c-index. Results The median number of LNs removed was 14 (IQR 9, 20) and the median number of positive LNs was 1 (IQR 1, 2). With a median follow-up of 4.6 years (IQR 3.2-6.0 years), 155/261 patients experienced BCR; 5-year BCR-free survival 39% [95% CI 33%, 46%]. The median diameter of the largest metastatic LN was 9 mm (IQR 5, 16). On Cox regression, RP specimen Gleason score (>7 vs. ≤7), number of positive LNs (≥3 vs. 1-2), SVI and PSA were associated with significantly increased risks of BCR. In a subset analysis, size of the metastasis significantly improved the discrimination of the model (Harrell's C 0.700 vs. 0.655 for the base model, p=0.032). Conclusion Our study confirms that the number of positive LNs is a predictor of BCR in men with node-positive disease. The improvement in prognostic value of measuring the metastatic focus warrants further investigation.

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Section: Introductionmentioning

confidence: 99%

Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate Cancer

et al. 2013

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“…Extracapsular extension (ENE) of tumour beyond the LN was reported to have prognostic significance in one early study,60 however subsequent studies have not found ENE to be an independent prognosticator in patients with prostate cancer with LN metastases 53–57 61 62. Similarly, Boormans et al 56 found a Gleason Score >7 within the LN metastasis to be a predictor of survival.…”

Section: Metastatic Tumour Burden and Prognostic Histopathological Pamentioning

confidence: 99%

Lymph node staging in prostate cancer: perspective for the pathologist

Prendeville

Kwast

2016

J Clin Pathol

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Pelvic lymph node dissection (PLND) currently represents the gold standard method for nodal staging in the setting of localised prostate cancer and may also have a therapeutic benefit in certain patients. The histopathological evaluation of PLND specimens plays a critical role in accurate lymph node staging, however there is currently a lack of consensus regarding the optimum approach and no quality parameters are in place. In addition, there are no guidelines as to the handling of less commonly encountered nodal specimens such as those identified within the anterior fat pad. This summary provides an overview of pertinent issues regarding lymph node staging in prostate cancer, with a focus on the histopathological evaluation of resected nodal specimens. We hope that this review will further the discussion on how to achieve a more standardised approach to the processing and reporting of PLND specimens in the setting of prostate cancer.

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“…All prostatectomy and lymphadenectomy specimens were processed at the Institute of Pathology, University of Bern as previously described [3,13]. For this study, all slides were re-evaluated by experienced genitourinary pathologists (AF, CR, and NS).…”

Section: Pathologymentioning

confidence: 99%

“…P values less than 0.05 were considered significant for all tests. After verification of the proportional hazards assumption, multiple Cox regression analysis was used for all three endpoints to determine the prognostic impact of CD10 expression in primary tumors and metastases controlling for independent risk factors determined previously in a subset of this cohort [3,13]: Gleason score of the primary tumor (6/7/8 vs. 9/10 grouped according to similar survival curves between the clustered subsets) and lymph node tumor burden reflected by the total diameter of all nodal metastases (median value, 7.5 mm, was used as cut-off).…”

Section: Immunohistochemistrymentioning

confidence: 99%

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High CD10 expression in lymph node metastases from surgically treated prostate cancer independently predicts early death

et al. 2011

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Patients with nodal positive prostate cancers are an important cohort with poorly defined risk factors. CD10 is a cell surface metallopeptidase that has been suggested to play a role in prostate cancer progression. CD10 expression was evaluated in 119 nodal positive prostate cancer patients using tissue microarrays constructed from primary tumors and lymph node metastases. All patients underwent radical prostatectomy and standardized extended lymphadenectomy. They had no neoadjuvant therapy and received deferred androgen deprivation. In the primary tumor, high CD10 expression was significantly associated with earlier death from disease when compared with low CD10 expression (5-year survival 73.7% vs. 91.8%; p = 0.043). In the metastases, a high CD10 expression was significantly associated with larger total size of metastases (median 11.4 vs. 6.5 mm; p = 0.015), earlier death of disease (5-year survival 71.5% vs. 87.3%; p = 0.017), and death of any cause (5-year survival 70.0% vs. 87.2%; p = 0.001) when compared with low CD10 expression. CD10 expression in the metastases added independent prognostic information for overall survival (p = 0.029) after adjustment for Gleason score of the primary tumor, nodal tumor burden, and resection margins. In conclusion, a high CD10 expression in prostate cancer predicts early death. This information is inherent in the primary tumors and in the lymph node metastases and might help to personalize patient management.

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Prognostic factors in lymph node metastases of prostatic cancer patients: the size of the metastases but not extranodal extension independently predicts survival

Cited by 42 publications

References 35 publications

Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate Cancer

Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate Cancer

Lymph node staging in prostate cancer: perspective for the pathologist

High CD10 expression in lymph node metastases from surgically treated prostate cancer independently predicts early death

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