Determinants of Long-term Survival of Patients With Locally Advanced Prostate Cancer

The Role of Extensive Pelvic Lymph Node Dissection

M Moschini; N Fossati; F Abdollah; G Gandaglia; V Cucchiara; P Dell'Oglio; S Luzzago; SF Shariat; F Dehò; A Salonia; F Montorsi; A Briganti

Disclosures

Prostate Cancer Prostatic Dis. 2016;19(1):63-67.

Conclusion

Our results showed that, in PCa patients with pathological advanced local stage, the removal of a higher number of nodes during RP was associated with an improvement in cancer-specific survival rate. This implies that an ePLND should be considered in all patients with a significant preoperative risk of harboring adverse pathological stage.

1 2 3 4 5

Next Section

Table 1. Descriptive statistics of the cohort of 1586 patients with non-metastatic pT3-pT4 prostate cancer treated with radical prostatectomy and extended pelvic lymph node dissection between 1987 and 2014 at one tertiary care center
Variables	Entire cohort (n=1586, 100%)
Age at surgery, years
Mean	65.8
Median (IQR)	66.1 (61.1–70.9)
PSA, ng ml⁻¹
Mean	20.5
Median (IQR)	9.6 (6.3–18.6)
Type of surgery
Robotic-assisted radical prostatectomy	253 (16.0%)
Open radical prostatectomy	1333 (84.0%)
D'amico risk group
Low risk	132 (8.3%)
Intermediate risk	589 (37.1%)
High risk	717 (45.2%)
Unknown	148 (9.3%)
Removed lymph nodes
Mean	19.0
Median (IQR)	17 (11–23)
Positive lymph nodes
Mean	1.7
Median (IQR)	0 (0–1)
Pathological Gleason score
2–6	184 (11.6%)
7	807 (50.9%)
8–10	595 (37.5%)
PSM	656 (41.4%)
LNI	655 (41.3%)
Adjuvant HT	547 (34.5%)
Adjuvant RT	865 (54.5%)
Salvage HT	79 (5.0%)
Salvage RT	119 (7.5%)

Abbreviations: HT, hormonotherapy; IQR, interquartile range; LNI, lymph node invasion; PSM, positive surgical margin; RT, radiotherapy.

Table 2. Univariable and multivariable Cox regression analyses predicting cancer-specific mortality and overall mortality in 1586 pT3-pT4 prostate cancer patients treated with radical prostatectomy
Variables	Cancer-specific mortality
	Univariate analysis		Multivariate analysis
	HR (95% CI)	P	HR (95% CI)	P
Age, years	1.02 (1.00–1.04)	0.07	1.08 (1.04–1.13)	<0.001
PSA, ng ml⁻¹	1.00 (1.00–1.00)	0.01	1.00 (1.00–1.00)	0.7
Positive surgical margin	1.84 (1.25–2.72)	0.002	1.76 (0.87–3.57)	0.1
Number of positive nodes	1.03 (1.02–1.05)	<0.001	1.06 (1.01–1.12)	0.03
Number of nodes removed	1.02 (1.00–1.03)	0.01	0.94 (0.90–0.99)	0.02
Type of surgery
Open surgery	Ref.	0.6	Ref.	0.6
Robotic surgery	0.82 (0.40–1.70)		0.80 (0.33–1.92)
GS pathological
2–6	Ref.	<0.001	Ref.	<0.001
7	1.08 (0.62–1.89)	0.8	0.72 (0.44–1.66)	0.3
8–10	4.28 (2.60–7.05)	<0.001	2.46 (1.29–4.80)	0.02
ADJ RT	0.69 (0.47–1.02)	0.06	0.54 (0.42–0.81)	0.02
ADJ HT	2.82 (1.87–4.26)	<0.001	1.59 (0.48–5.27)	0.4