The Impact of Lymph Node Metastases Burden at Radical Prostatectomy.
Adolescent
Adult
Age Factors
Aged
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
/ pathology
Male
Middle Aged
Neoplasm Grading
Proportional Hazards Models
Prostatectomy
/ statistics & numerical data
Prostatic Neoplasms
/ mortality
Retrospective Studies
Risk Factors
SEER Program
Survival Analysis
Young Adult
Cancer-specific survival
Lymph node metastases
Prostate cancer
Radical prostatectomy
SEER database
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
18
10
2017
revised:
08
12
2017
accepted:
19
12
2017
pubmed:
8
1
2018
medline:
10
10
2020
entrez:
8
1
2018
Statut:
ppublish
Résumé
We hypothesized that a cut-off in positive lymph node (LN) counts may discriminate between cancer-specific mortality (CSM) rates in clinically localized prostate cancer patients treated with radical prostatectomy (RP). To test this relationship, we relied on different LN count cut-offs, as well as the continuously coded number of positive LNs (NPN). Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP and pelvic LN dissection, regardless of pathologic LN stage. Kaplan-Meier analyses and multivariable Cox regression models tested the effect of LN invasion (LNI) on CSM, according to the NPN. Of 30016 patients treated with RP, 6.2% (n=1869) exhibited LNI, with respectively higher rates of LNI in patients with D'Amico high- versus intermediate-risk characteristics (11.6% vs 3.4%). Overall, the median age was 63yr, median prostate-specific antigen value was 6.6ng/ml and the median number of removed LNs was six. At 60 mo after RP, CSM rates were, respectively, 6.0% versus 0.8% for patients with and without LNI: multivariable hazard ratio (HR) 4.4 (p<0.001). CSM rates were, respectively, 0.8% for NPN 0, 2.4% for NPN 1-2 (HR: 3.5, p<0.001), and 7.2% for NPN ≥3 (HR: 10.3, p<0.001). The NPN is an independent predictor of higher CSM rate. Specifically, patients with one to two positive LNs are at moderately higher risk of CSM than those without LNI, and CSM risk increases sharply in those with ≥3 positive LNs. Our contemporary findings corroborate the NPN cut-offs within previous studies. Patients with three or more positive lymph nodes at radical prostatectomy have significantly higher cancer-specific mortality rates than those without or one to two positive lymph nodes. This stratification can be useful in considering adjuvant treatment options.
Sections du résumé
BACKGROUND
We hypothesized that a cut-off in positive lymph node (LN) counts may discriminate between cancer-specific mortality (CSM) rates in clinically localized prostate cancer patients treated with radical prostatectomy (RP).
OBJECTIVE
To test this relationship, we relied on different LN count cut-offs, as well as the continuously coded number of positive LNs (NPN).
METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP and pelvic LN dissection, regardless of pathologic LN stage. Kaplan-Meier analyses and multivariable Cox regression models tested the effect of LN invasion (LNI) on CSM, according to the NPN.
RESULTS
Of 30016 patients treated with RP, 6.2% (n=1869) exhibited LNI, with respectively higher rates of LNI in patients with D'Amico high- versus intermediate-risk characteristics (11.6% vs 3.4%). Overall, the median age was 63yr, median prostate-specific antigen value was 6.6ng/ml and the median number of removed LNs was six. At 60 mo after RP, CSM rates were, respectively, 6.0% versus 0.8% for patients with and without LNI: multivariable hazard ratio (HR) 4.4 (p<0.001). CSM rates were, respectively, 0.8% for NPN 0, 2.4% for NPN 1-2 (HR: 3.5, p<0.001), and 7.2% for NPN ≥3 (HR: 10.3, p<0.001).
CONCLUSIONS
The NPN is an independent predictor of higher CSM rate. Specifically, patients with one to two positive LNs are at moderately higher risk of CSM than those without LNI, and CSM risk increases sharply in those with ≥3 positive LNs. Our contemporary findings corroborate the NPN cut-offs within previous studies.
PATIENT SUMMARY
Patients with three or more positive lymph nodes at radical prostatectomy have significantly higher cancer-specific mortality rates than those without or one to two positive lymph nodes. This stratification can be useful in considering adjuvant treatment options.
Identifiants
pubmed: 29306731
pii: S2405-4569(17)30296-1
doi: 10.1016/j.euf.2017.12.009
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
399-406Informations de copyright
Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.