ORLANDO, FL USA (UroToday.com) - The association between the extent of pelvic lymph node dissection (PLND) and patient survival remains still unclear in prostate cancer. Only a few retrospective reports found an association between the extent of PLND and patient outcome. However, these studies are limited by the lack of standardized anatomical template of nodal dissection. The study group tested the association between the extent of nodal dissection and patient survival in a single-center cohort of node-positive patients treated with extended pelvic lymph node dissection (ePLND).
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The study included a total of 540 consecutive node-positive patients treated with radical prostatectomy (RP) and anatomically defined ePLND at a single European tertiary referral centre between 1992 and 2010. PLND consisted of removal of obturator, external iliac, hypogastric +/- pre-sacral and common iliac lymph nodes. Kaplan-Meier curves assessed time to cancer-specific and overall survival. Moreover, univariable and multivariable Cox regression analyses were performed to address predictors of cancer-specific and overall mortality. Covariates consisted of patient age and PSA at surgery, pathological Gleason sum, pathological stage, number of positive lymph nodes, number of lymph nodes removed, and adjuvant radiation and hormonal therapy.
The mean follow-up was 65 months (median: 63). Mean age at surgery was 65.5 years (median 66). Mean and median PSA at surgery was 26.6 and 11.5 ng/ml, respectively. Pathological stage was pT2, pT3a, pT3b and pT4 in 9.1%, 20%, 64.3% and 6.5% respectively. Pathological Gleason score 8-10 was present in 50.7% of patients. Mean and median number of lymph nodes removed were 21 and 19, respectively. Mean and median number of positive lymph nodes were 3.7 and 2, respectively. 39.8% and 84.4% of the patients received adjuvant radiotherapy, and hormonal therapy, respectively. The 8 and 10-year cancer specific and overall survival rates were 85 and 80%, and 73.4 and 70%. At multivariable analyses, after adjusting for all confounders, the number of lymph nodes removed was significantly inversely associated with both cancer-specific and overall mortality (p= 0.02; HR: 0.92 and p=0.01; 0.93, respectively). The number of positive lymph nodes, pathological Gleason score 8-10, and adjuvant RT were also significantly associated with patient survival (all p ≤ 0.02).
The authors conclude that in node-positive patients more extensive PLND is significantly associated with improved cancer-specific and overall survival rates. Therefore, in these patients, a meticulous PLND is advocated.
Presented by Firas Abdollah, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Written by Achim Lusch, MD, University of California (Irvine), and medical writer for UroToday.com