Journal
UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS
Volume 39, Issue 4, Pages -Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.urolonc.2020.10.010
Keywords
lymph node; Biochemical recurrence; Organ confined prostate cancer; Natural history; Metastasis-free survival
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In this study, the impact of lymph-node involvement on oncological outcomes in patients with pathologically organ-confined prostate cancer after radical prostatectomy was investigated. Patients with pathologically organ-confined but lymph node-positive cancer showed favorable outcomes, but presence of 3 or more positive lymph nodes predicted higher rates of biochemical recurrence and metastatic progression, suggesting consideration of adjuvant treatment in these cases.
Background: The aim of this study was to investigate the impact of lymph-node involvement on oncological outcomes in patients with pathologically organ-confined prostate cancer (pT2 CaP) after radical prostatectomy (RP). Methods: We retrospectively analyzed 9,631 pT2 CaP patients who underwent RP at a single institution between 1998 and 2018. Kaplan-Meier plots and Cox regression models (CRMs) assessed biochemical recurrence (BCR)-free survival and metastasis-free survival (MFS) according to N-stage. In subgroup analyses of N1 patients, Kaplan-Meier plots and CRMs were stratified according to adjuvant treatment. Results: Of 9,631 pT2 staged patients, 241 (2.5%) harbored lymph-node metastases after RP (pN1). The median follow-up was 60.8 months. No pT2 N1-staged patient died due to CaP. The 5-year BCR-free survival rates were 54.7 vs. 88.4% in pT2 N1 vs. pT2 N0 patients, respectively (P < 0.001). The 5-year MFS rates were 92.5 vs. 98.9% in pT2 N1 vs. pT2 N0 patients, respectively (P < 0.001). Within pT2 N1 patients, presence of >= 3 positive lymph nodes was an independent risk factor for BCR (hazard ratio [HR] 3.4, P < 0.001) and for metastatic progression (HR 1.7, P = 0.04). Finally, 3-year BCR-free survival was improved in pT2 N1 patients treated with adjuvant radiation therapy (87.1% vs. 63.7% for patients who received other treatment options [P < 0.001]). Conclusion: Patients with pathologically organ-confined but lymph node-positive CaP exhibited favorable oncological outcomes after RP. Presence of >= 3 positive LNs predicted higher rates of BCR and metastatic progression. In consequence, in pT2 N1 patients treated with RP with >= 3 positive LNs, adjuvant treatment may be considered.9 (C) 2020 Elsevier Inc. All rights reserved.
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