PURPOSE: Clinical practice guidelines recommend pelvic lymph node dissection (PLND) at the time of surgery for intermediate or high-risk prostate cancer (PCa).
FREE DAILY AND WEEKLY NEWSLETTERS OFFERED BY CONTENT OF INTEREST
Did you find this article relevant? Subscribe to UroToday-GUOncToday!
The fields of GU Oncology and Urology are advancing rapidly including new treatments, enrolling clinical trials, screening and surveillance recommendations along with updated guidelines. Join us as one of our subscribers who rely on UroToday as their must-read source for the latest news and data on drugs. Sign up today for blogs, video conversations, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.
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.
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.