AUA 2019: Predictors of Long-term Mortality in Patients with Positive Lymph Nodes at Radical Prostatectomy
Dr. Ulrike Heberling presented her group’s study evaluating the predictors of long-term mortality in patients with positive lymph nodes at the time of radical prostatectomy. They retrospectively evaluated 5997 patients who underwent radical prostatectomy (RP) between 1992-2014 and found 564 patients with positive lymph nodes at the time of RP. They found that the average nodal yield at the time of lymphadenectomy was 14.6. The mean follow-up of these patients was 9.9 years. They then performed a multivariate competing risk analysis with prostate cancer mortality as an endpoint. The variates involved were age, year of surgery, Gleason score, tumor stage, PSA, lymph node density, lymph node yield, and the number of positive lymph nodes.
They found that at 20 years of follow-up, 25% of patients had died of competing causes, while 29% of patients died of prostate cancer. On their multivariate analysis, only the lymph node density (defined as the number of lymph nodes involved per number of lymph nodes removed), and Gleason score predicted prostate cancer mortality.
They concluded that prostate cancer mortality in patients with involved lymph nodes is likely dictated by cancer biology. Patients with lower Gleason scores and those with low lymph node densities (<11%) appear to have excellent cancer-specific outcomes.
Presented by: Ulrike Heberling, MD, Dresden, Germany
Written by: Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, Pennsylvania, @btkmduro at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois