AUA 2018: Impact of Lymph Node Count and Adjuvant Therapy on Oncologic Outcomes in Node Positive Patients with Prostate Cancer

San Francisco, CA ( In this abstract, Selma Masic, MD and colleagues evaluated the associations between oncologic outcomes and nodal count in patients with positive nodes at radical prostatectomy.  Additionally, they sought to determine if there was an association between adjuvant therapy in node positive patients that improved oncologic outcomes.  Pelvic lymph node dissection is the most definitive lymph node staging modality for prostate cancer.  While newer imaging methods are actively being investigated, previous studies have demonstrated that existing imaging with CT and MRI have low sensitivity.

Furthermore, oncologic benefits of lymph node dissection are still under debate as a diagnostic versus therapeutic benefit.  Some studies have shown survival and biochemical recurrence improvements, while others report no benefit with higher rates of complications.

Masic evaluated patients from 43 different CAPSURE study sites who underwent radical prostatectomy and had node-positive disease from 1990-2016.  266 patients were included in the analysis, where biochemical recurrence, bone metastasis, prostate cancer-specific mortality was evaluated.  Additionally, Cox regression models analyzed oncologic outcome with lymph node yield, adjuvant therapy (none vs EBRT vs ADT) and CAPRA risk score.

Median lymph node yield varied from 5-12 depending on the year.  On univariate analysis, evaluating all men who underwent prostatectomy, patients with node-positive disease had a worse recurrence-free, metastasis-free, and prostate cancer-specific survival (all p<0.01).  Stratified by the number of positive nodes (1 vs >2), no differences were seen in recurrence-free, metastasis-free, or prostate cancer specific survival (all p>0.09).  Similar trends were identified for lymph node yield (LN<14 vs LN>14; (all p>0.16). 

Furthermore, 70% of node-positive patients had post radical prostatectomy treatment, which was split evenly between ADT and EBRT.  On univariate analysis, prostate cancer specific mortality did have a statistically significant survival advantage for patients receiving adjuvant therapy (p=0.05).

On multivariate analysis, however, no differences in survival outcomes were demonstrated with lymph node yield or post-prostatectomy adjuvant therapy. 

Further prospective studies are needed to help elucidate this information.

Presented by: Selma Masic, MD, University of California – San Francisco
Co-Authors: Hao Nguyen, Janet Cowan, San Francisco, CA, Michael Leapman, New Haven, CT, Peter Carroll, San Francisco, CA

Written by:  David B. Cahn, DO, MBS Fox Chase Cancer Center Philadelphia, PA @dbcahn at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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