ACS 2018: Lymphadenectomy for High-Risk Prostate Cancer Patients: What is Going on in Georgia?

Boston, Massachusetts ( Mark Henry, MD evaluated variation in use across 18 geographically-defined cancer registries in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. He and his colleagues identified all high-risk prostate cancer patients diagnosed between 2010-2014 and treated with radical prostatectomy. Risk stratification was based on D'Amico criteria. We evaluated trends in lymphadenectomy, stratified by cancer registry of residence.  Analysis was performed at the patient level, adjusted for age and race/ethnicity, using a multivariable regression model.

A total of 69,184 of the 77,602 prostate cancer patients treated with radical prostatectomy had complete data to allow risk stratification. 13,091 (18.9%) were high-risk, and 11,249 (85.9%) received lymphadenectomy. Lymphadenectomy increased with time (84.4% in 2010 to 87.8% in 2014; p=0.007). We found variation in the proportion of lymphadenectomy patients with removal of 10+ nodes, (15.5% in Hawaii to 41.4% in San Francisco-Oakland; p<0.001). The registries performing lymphadenectomy most frequently were Seattle (93.4%), San Jose-Monterey (93.3%), and New Jersey (91.6%). After age and race/ethnicity adjustment, the Atlanta (78.1%, OR 0.39, 95% CI 0.35 – 0.44), Greater Georgia (73.6%, OR 0.45, 95% CI 0.41 – 0.48), and Rural Georgia (68.8%, OR 0.37, 95% CI 0.22 – 0.62) registries performed lymphadenectomy the least frequently.

In summary, lymphadenectomy in high-risk prostate cancer patients treated with radical prostatectomy varied considerably by geography, with particular deficits noted in the state of Georgia. These findings cannot be explained by differences in distribution in age or race/ethnicity, and merit further investigation into factors explaining these findings.

Presented by: Mark Henry, MD, Urologist, Emory University School of Medicine, Decatur, GA

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts