Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases

Fleischmann, Achim; Schobinger, Sylviane; Schumacher, Martin; Thalmann, George N.; Studer, Urs E.

doi:10.1002/pros.20889

Cited by 62 publications

(92 citation statements)

References 38 publications

(72 reference statements)

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“…Results support the conclusions of others that patients with a higher number of positive LNs are at increased risk for BCR and cancer specific death. 12, 23 Palapattu et al retrospectively reviewed the records of 3,264 patients treated with RP and PLND, of whom 143 had LN involvement.13 Similar to our findings, they observed that higher Gleason score and greater LN burden were associated with worse prognosis and increased BCR risk. 13 Fleischmann et al retrospectively evaluated histopathological risk factors in a cohort of 102 patients with positive LNs at RP.…”

Section: Discussionsupporting

confidence: 75%

“…12, 23 Palapattu et al retrospectively reviewed the records of 3,264 patients treated with RP and PLND, of whom 143 had LN involvement.13 Similar to our findings, they observed that higher Gleason score and greater LN burden were associated with worse prognosis and increased BCR risk.13 Fleischmann et al retrospectively evaluated histopathological risk factors in a cohort of 102 patients with positive LNs at RP. 23 They suggested that involved LN diameter (10 or less vs greater than 10 mm) and "micrometastasis only status" were significantly associated with the likelihood of BCR. Stratifying our patients into subgroups based on the number of positive LNs and specimen Gleason score showed a remarkable difference in recurrence-free probability.…”

Section: Discussionmentioning

confidence: 99%

“…13 Fleischmann et al retrospectively evaluated histopathological risk factors in a cohort of 102 patients with positive LNs at RP. 23 They suggested that involved LN diameter (10 or less vs greater than 10 mm) and "micrometastasis only status" were significantly associated with the likelihood of BCR. Stratifying our patients into subgroups based on the number of positive LNs and specimen Gleason score showed a remarkable difference in recurrence-free probability.…”

Section: Discussionmentioning

confidence: 99%

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660 Predicting Biochemical Recurrence Free Survival in Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

et al. 2010

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Purpose-We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy.Materials and Methods-Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method.Results-A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes.Conclusions-Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal. Keywordsprostate; prostatic neoplasms; lymph node excision; neoplasm metastasis; prognosis The role of pelvic LN dissection and treatment in patients with LN metastasis after RP remain controversial. The risk of LN metastasis in men who undergo RP for clinically localized prostate cancer is 3% to 24%. [1][2][3][4][5][6] Patients with positive LNs at RP can have different outcomes. Some men never achieve undetectable PSA while others remain free of BCR for prolonged periods. Consequently ideal management for positive LNs at RP is In all treated patients RP was done contemporaneously with our study. Frozen sections were not routinely used. All RP specimens were serially sectioned at 3 to 5 mm, entirely submitted for permanent section and examined on whole mount slides. All LN specimens were sent en bloc for permanent section pathological analysis. After fixation in 10% neutral buffered formalin the LNs were meticulously dissected and counted manually by the pathologists. Each identified LN was cut when appropriate, embedded in paraffin, sectioned at 5 µm, stained with hematoxylin and eosin, and examined microscopically. No immunohistochemical staining for keratin or PSA and no reverse transcriptase-polymerase chain reaction technology was used. Residual...

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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660 Predicting Biochemical Recurrence Free Survival in Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

et al. 2010

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“…Several studies have demonstrated that characteristics of the primary tumor influence the outcome of pN1 patients [1,2,10,15,16,17,18]. In this study, besides pathological T stage, the most relevant parameters identified via univariate and multivariate analyses included the pathological state of the intersection margin and pathological Gleason score; both factors significantly affected the outcome of the patient population.…”

Section: Discussionmentioning

confidence: 93%

“…This evaluation included preoperative data, surgical treatment, and, finally, postoperative follow-up data. The tumor burden of LNI per patient was determined according to the following variables: (1) the total number of nonaffected and affected SLN as well as the equivalent number of non-SLN; (2) the total diameter (in millimeters) of affected SLN and non-SLN metastases; (3) the presence of macro- and/or micrometastases (micrometastasis defined as >0.2 and ≤2 mm) [15]. …”

Section: Methodsmentioning

confidence: 99%

Clinical Outcome of Patients with Lymph Node-Positive Prostate Cancer following Radical Prostatectomy and Extended Sentinel Lymph Node Dissection

Mück¹,

Langesberg

Mugler³

et al. 2014

Urol Int

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Objective: This study sought to evaluate the clinical outcome after extended sentinel lymph node dissection (eSLND) and radical retropubic prostatectomy (RRP) in patients with clinically localized prostate cancer (PCa). Subjects and Methods: From August 2002 until February 2011, a total of 819 patients with clinically localized PCa, confirmed by biopsy, were treated with RRP plus eSLND. Biochemical recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were assessed with Kaplan-Meier curves. Various histopathological parameters were analyzed by univariate and multivariate analysis. Results: The mean follow-up was 5.3 years. Lymph node (LN) metastases occurred in 140 patients. We removed an average of 10.9 LNs via eSLND from patients with pN1 PCa. Postoperatively, 121 pN1 patients temporarily received adjuvant androgen deprivation therapy. The mean survival periods for RFS, RFS after secondary treatment, CSS, and OS were 4.7, 7.0, 8.8, and 8.1 years, respectively. The cancer-specific death rate of the 140 pN1 patients was 13.6%. RFS, CSS, and OS were significantly correlated with pathological margin status, LN density, the total diameter of evident metastases, and membership in the subgroup ‘micrometastases only'. Conclusion: Despite the presence of LN metastases, patients with a low nodal tumor burden demonstrate a remarkable clinical outcome after undergoing eSLND and RRP, thus suggesting a potential curative therapeutic approach.

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Does quantification of USPIO uptake‐related signal loss allow differentiation of benign and malignant normal‐sized pelvic lymph nodes?

Froehlich

Triantafyllou

Fleischmann³

et al. 2012

Contrast Media & Molecular

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Ultrasmall superparamagnetic iron oxide (USPIO) particles are promising contrast media, especially for molecular and cellular imaging besides lymph node staging owing to their superior NMR efficacy, macrophage uptake and lymphotropic properties. The goal of the present prospective clinical work was to validate quantification of signal decrease on high-resolution T(2)-weighted MR sequences before and 24-36 h after USPIO administration for accurate differentiation between benign and malignant normal-sized pelvic lymph nodes. Fifty-eight patients with bladder or prostate cancer were examined on a 3 T MR unit and their respective lymph node signal intensities (SI), signal-to-noise (SNR) and contrast-to-noise (CNR) were determined on pre- and post-contrast 3D T(2)-weighted turbo spin echo (TSE) images. Based on histology and/or localization, USPIO-uptake-related SI/SNR decrease of benign vs malignant and pelvic vs inguinal lymph nodes was compared. Out of 2182 resected lymph nodes 366 were selected for MRI post-processing. Benign pelvic lymph nodes showed a significantly higher SI/SNR decrease compared with malignant nodes (p < 0.0001). Inguinal lymph nodes in comparison to pelvic lymph nodes presented a reduced SI/SNR decrease (p < 0.0001). CNR did not differ significantly between benign and malignant lymph nodes. The receiver operating curve analysis yielded an area under the curve of 0.96, and the point with optimal accuracy was found at a threshold value of 13.5% SNR decrease. Overlap of SI and SNR changes between benign and malignant lymph nodes were attributed to partial voluming, lipomatosis, histiocytosis or focal lymphoreticular hyperplasia. USPIO-enhanced MRI improves the diagnostic ability of lymph node staging in normal-sized lymph nodes, although some overlap of SI/SNR-changes remained. Quantification of USPIO-dependent SNR decrease will enable the validation of this promising technique with the final goal of improving and individualizing patient care.

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Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases

Cited by 62 publications

References 38 publications

660 Predicting Biochemical Recurrence Free Survival in Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

660 Predicting Biochemical Recurrence Free Survival in Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

Clinical Outcome of Patients with Lymph Node-Positive Prostate Cancer following Radical Prostatectomy and Extended Sentinel Lymph Node Dissection

Does quantification of USPIO uptake‐related signal loss allow differentiation of benign and malignant normal‐sized pelvic lymph nodes?

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