Variation in pelvic lymph node dissection among patients undergoing radical prostatectomy by hospital characteristics and surgical approach: Results from the National Cancer Database - Abstract

PURPOSE: Clinical practice guidelines recommend pelvic lymph node dissection (PLND) at the time of surgery for intermediate or high-risk prostate cancer (PCa).

Therefore, we sought to examine the relationship of PLND and detection of lymph node metastasis with hospital characteristics and surgical approach among PCa patients.

METHODS: Using the National Cancer Data Base (NCDB), we identified surgically treated patients with pretreatment intermediate- or high-risk disease from 2010 to 2011. The primary outcomes were receipt of PLND and extended PLND and detection of lymph node metastasis. Multivariable logistic regression models were used to test whether hospital characteristics and surgical approach were associated with each outcome.

RESULTS: Among the 50,671 surgically treated patients, 70.8% (n=35,876) received a concomitant PLND, 26.6% (n=9,543) underwent extended PLND, and 4.5% (n=1,621) had lymph node metastasis. PLND was performed more often at high-volume compared with low-volume hospitals (81.2% vs. 65.4% adjusted OR: 2.20; p=0.01), but less frequently with robotic-assisted radical prostatectomy [RARP] compared with open radical prostatectomy [ORP] (67.5% vs. 81.8%; adjusted OR: 0.30; p< 0.001). Higher odds ratios for lymph node metastasis were also demonstrated with high vs. low volume (OR: 1.35; p=0.01) and academic vs. community (OR: 1.35; p< 0.001) hospitals. However, patients treated by RARP had lower odds ratios for lymph node metastasis relative to those undergoing ORP (OR: 0.56; p< 0.001).

CONCLUSIONS: In this cohort, a third of patients are not receiving guideline-recommended treatment with PLND for PCa. PLND and detection of lymph node metastasis varied by surgical approach and hospital volume and academic status.

Written by:
Wang EH, Yu JB, Gross CP, Smaldone MC, Shah ND, Trinh QD, Nguyen PL, Sun M, Han LC, Kim SP.   Are you the author?
Institution(s): See publishing journal.

Reference: J Urol. 2014 Sep 18. pii: S0022-5347(14)04412-7.
doi: 10.1016/j.juro.2014.09.019

PubMed Abstract
PMID: 25242393 Prostate Cancer Section