Long-term Outcomes of Patients with Lymph Node Metastasis Treated with Radical Prostatectomy Without Adjuvant Androgen-deprivation Therapy

• Published in: European urology Vol. 65; no. 1; pp. 20 - 25
• Main Authors: Touijer, Karim A, Mazzola, Clarisse R, Sjoberg, Daniel D, Scardino, Peter T, Eastham, James A
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.01.2014; Elsevier
• Subjects: Aged; Androgen Antagonists; Biochemical recurrence; Biological and medical sciences; Chemotherapy, Adjuvant; Disease-Free Survival; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymph node dissection; Lymph Node Excision; Lymph node metastasis; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prognosis; Prostate; Prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radical prostatectomy; Retrospective Studies; Staging; Time Factors; Treatment Outcome; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Lymph node metastasis; Prognosis; Lymph node dissection; Radical prostatectomy; Staging; Prostate; Prostate cancer; Biochemical recurrence; Nephrology; Prostate disease; Adjuvant treatment; Malignant lymphadenopathy; Urology; Lymphadenectomy; Surgery; Urogenital system; Male genital diseases; Human; Urinary system disease; Androgen deprivation therapy; Stage classification; Malignant hemopathy; Malignant tumor; Long term; Prostatectomy; Cancer
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2013.03.053

Abstract Background The presence of lymph node metastasis (LNM) at radical prostatectomy (RP) is associated with poor outcome, and optimal treatment remains undefined. An understanding of the natural history of node-positive prostate cancer (PCa) and identifying prognostic factors is needed. Objective To assess outcomes for patients with LNM treated with RP and lymph node dissection (LND) alone. Design, setting, and participants We analyzed data from a consecutive cohort of 369 men with LNM treated at a single institution from 1988 to 2010. Intervention RP and extended LND. Outcome measurements and statistical analysis Our primary aim was to model overall survival, PCa-specific survival, metastasis-free progression, and freedom from biochemical recurrence (BCR). We used univariate Cox proportional hazard regression models for survival outcomes. Multivariable Cox proportional hazard regression models were used for freedom from metastasis and freedom from BCR, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesical invasion, surgical margin status, and number of positive nodes as predictors. Results and limitations Sixty-four patients with LNM died, 37 from disease. Seventy patients developed metastasis, and 201 experienced BCR. The predicted 10-yr overall survival and cancer-specific survival were 60% (95% confidence interval [CI], 49–69) and 72% (95% CI, 61–80), respectively. The 10-yr probability of freedom from distant metastasis and freedom from BCR were 65% (95% CI, 56–73) and 28% (95% CI, 21–36), respectively. Higher pathologic Gleason score (>7 compared with ≤7; hazard ratio [HR]: 2.23; 95% CI, 1.64–3.04; p < 0.0001) and three or more positive lymph nodes (HR: 2.61; 95% CI, 1.81–3.76; p < 0.0001) were significantly associated with increased risk of BCR on multivariable analysis. The retrospective nature and single-center source of data are study limitations. Conclusions A considerable subset of men with LNM remained free of disease 10 yr after RP and extended LND alone. Patients with pathologic Gleason score <8 and low nodal metastatic burden represent a favorable group. Our data confirm prior findings and support a plea for risk subclassification for patients with LNM.