Clinical significance of limited and extended pelvic lymph node dissection during robot-assisted radical prostatectomy for patients with localized prostate cancer: A retrospective, propensity score matching analysis.
biochemical recurrence
extended pelvic lymph node dissection
limited pelvic lymph node dissection
prostate cancer
robot-assisted radical prostatectomy
Journal
International journal of urology : official journal of the Japanese Urological Association
ISSN: 1442-2042
Titre abrégé: Int J Urol
Pays: Australia
ID NLM: 9440237
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
09
06
2022
accepted:
28
09
2022
pubmed:
29
10
2022
medline:
15
2
2023
entrez:
28
10
2022
Statut:
ppublish
Résumé
We investigated the diagnostic and therapeutic benefits of limited or extended pelvic lymph node dissection during a robot-assisted radical prostatectomy for localized prostate cancer. Diagnostic and therapeutic benefits were assessed according to the rates of pN1 and biochemical recurrence, respectively. The primary outcome was the biochemical recurrence-free rate, and secondary outcomes included the diagnostic and therapeutic benefits of pelvic lymph node dissection. A total of 534 patients were analyzed. Out of the 534 patients, 207 (38.8%) received limited pelvic lymph node dissection while 134 (25.1%) received extended dissection. There were 297 patients with a Briganti index ≥5%. Extended dissections yielded significantly more resected lymph nodes (p < 0.0001), and 72.2% of cases of pN1 were located outside the obturator. The incidence rate of pN1 was 6.1%, and performance of extended lymph node dissection was an independent predictor for pN1 (odds ratio 9.0, 95% confidence interval 2.5-33.1). The rate of biochemical recurrence was 14.9%, and Cox proportional hazards regression analysis of the propensity score matched population revealed that patients with high or very-high risk tended to benefit from limited lymph node dissection (hazard ratio 8.4, 95% confidence interval 0.8-82.3) while the therapeutic benefit of extended dissection was unclear by comparison. Extended pelvic lymph node dissection significantly improves diagnostic accuracy; however, the therapeutic benefit of pelvic lymph node dissection was not observed in this study.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
168-175Informations de copyright
© 2022 The Japanese Urological Association.
Références
Mattei A, Fuechsel FG, Bhatta Dhar N, Warncke SH, Thalmann GN, Krause T, et al. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol. 2008;53(1):118-25.
Fossati N, Willemse PM, Van den Broeck T, van den Bergh RCN, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2017;72(1):84-109.
Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol. 2002;167(4):1681-6.
Boehm K, Beyer B, Tennstedt P, Schiffmann J, Budaeus L, Haese A, et al. No impact of blood transfusion on oncological outcome after radical prostatectomy in patients with prostate cancer. World J Urol. 2015;33(6):801-6.
Bivalacqua TJ, Pierorazio PM, Gorin MA, Allaf ME, Carter HB, Walsh PC. Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy. Urology. 2013;82(3):653-8.
Berglund RK, Sadetsky N, DuChane J, Carroll PR, Klein EA. Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urol. 2007;177(2):526-9.
Gandaglia G, Ploussard G, Isbarn H, Suardi N, De Visschere PJ, Futterer JJ, et al. What is the optimal definition of misclassification in patients with very low-risk prostate cancer eligible for active surveillance? Results from a multi-institutional series. Urol Oncol. 2015;33(4):164.e1-9.
Koo KC, Tuliao P, Komninos C, Choi YD, Chung BH, Hong SJ, et al. Prognostic impact of time to undetectable prostate-specific antigen in patients with positive surgical margins following radical prostatectomy. Ann Surg Oncol. 2015;22(2):693-700.
Bhatta-Dhar N, Reuther AM, Zippe C, Klein EA. No difference in six-year biochemical failure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients with localized prostate cancer. Urology. 2004;63(3):528-31.
Jung JH, Seo JW, Lim MS, Lee JW, Chung BH, Hong SJ, et al. Extended pelvic lymph node dissection including internal iliac packet should be performed during robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer. J Laparoendosc Adv Surg Tech A. 2012;22(8):785-90.
Kim KH, Lim SK, Kim HY, Shin TY, Lee JY, Choi YD, et al. Extended vs standard lymph node dissection in robot-assisted radical prostatectomy for intermediate- or high-risk prostate cancer: a propensity-score-matching analysis. BJU Int. 2013;112(2):216-23.
Touijer KA, Sjoberg DD, Benfante N, Laudone VP, Ehdaie B, Eastham JA, et al. Limited versus extended pelvic lymph node dissection for prostate cancer: a randomized clinical trial. Eur Urol Oncol. 2021;4(4):532-9.
Lestingi JFP, Guglielmetti GB, Trinh QD, Coelho RF, Pontes J Jr, Bastos DA, et al. Extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: early oncological outcomes from a randomized phase 3 trial. Eur Urol. 2021;79(5):595-604.
Tanaka N, Nakai Y, Miyake M, Anai S, Inoue T, Fujii T, et al. Trends in risk classification and primary therapy of Japanese patients with prostate cancer in Nara urological research and treatment group (NURTG) - comparison between 2004-2006, 2007-2009, and 2010-2012. BMC Cancer. 2017;17(1):616.
Tanaka N, Shimada K, Nakagawa Y, Hirao S, Watanabe S, Miyake M, et al. The optimal number of initial prostate biopsy cores in daily practice: a prospective study using the Nara Urological Research and Treatment Group nomogram. BMC Res Notes. 2015;8:689.
Hori S, Tanaka N, Nakai Y, Morizawa Y, Tatsumi Y, Miyake M, et al. Comparison of cancer detection rates by transrectal prostate biopsy for prostate cancer using two different nomograms based on patient's age and prostate volume. Res Rep Urol. 2019;11:61-8.
Nakai Y, Tanaka N, Fujii T, Miyake M, Anai S, Hori S, et al. Trends in risk classification at diagnosis and primary therapy for prostate cancer: An analysis of 10839 patients from the Nara Urological Research and Treatment Group registry between 2004 and 2015. Int J Urol. 2021;28(11):1164-70.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452-8.
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480-7.
Touijer KA, Mazzola CR, Sjoberg DD, Scardino PT, Eastham JA. Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy. Eur Urol. 2014;65(1):20-5.
Esen T, Falay O, Tarim K, Armutlu A, Koseoglu E, Kilic M, et al. 68Ga-PSMA-11 positron emission tomography/computed tomography for primary lymph node staging before radical prostatectomy: central review of imaging and comparison with histopathology of extended lymphadenectomy. Eur Urol Focus. 2021;7(2):288-93.
Tu X, Zhang C, Liu Z, Shen G, Wu X, Nie L, et al. The role of 68Ga-PSMA positron emission tomography/computerized tomography for preoperative lymph node staging in intermediate/high risk patients with prostate cancer: a diagnostic meta-analysis. Front Oncol. 2020;10:1365.
Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C, et al. 68Ga-PSMA positron emission tomography/computed tomography provides Accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol. 2016;70(4):553-7.
Franklin A, Yaxley WJ, Raveenthiran S, Coughlin G, Gianduzzo T, Kua B, et al. Histological comparison between predictive value of preoperative 3-T multiparametric MRI and 68 Ga-PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer. BJU Int. 2021;127(1):71-9.