Is More Always Better? An Assessment of the Impact of Lymph Node Yield on Outcome for Clinically Localized Prostate Cancer with Low/Intermediate Risk Pathology (pT2-3a/pN0) Managed with Prostatectomy Alone

Steven N Seyedin; Darrion L Mitchell; Sarah L Mott; J Kyle Russo; Chad R Tracy; Anthony N Snow; Jessica R Parkhurst; Mark C Smith; John M Buatti; John M Watkins

doi:10.1007/s12253-017-0349-5

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Is More Always Better? An Assessment of the Impact of Lymph Node Yield on Outcome for Clinically Localized Prostate Cancer with Low/Intermediate Risk Pathology (pT2-3a/pN0) Managed with Prostatectomy Alone

Journal article

Peer reviewed

Is More Always Better? An Assessment of the Impact of Lymph Node Yield on Outcome for Clinically Localized Prostate Cancer with Low/Intermediate Risk Pathology (pT2-3a/pN0) Managed with Prostatectomy Alone

Steven N Seyedin, Darrion L Mitchell, Sarah L Mott, J Kyle Russo, Chad R Tracy, Anthony N Snow, Jessica R Parkhurst, Mark C Smith, John M Buatti and John M Watkins

Pathology oncology research, Vol.25(1), pp.209-215

01/2019

DOI: 10.1007/s12253-017-0349-5

PMCID: PMC5924586

PMID: 29079967

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Abstract

The clinical impact of lymph node dissection extent remains undetermined in the contemporary setting, as reflected in care pattern variations. Despite some series demonstrating a direct relationship between number of lymph nodes identified and detection of nodal involvement, the correlation between lymph node yield and disease control or survival outcomes remains unclear. Patients with clinically localized prostate cancer, pre-RP PSA <30, and pT2-3a/N0 disease at RP were retrospectively identified from two databases for inclusion. Those who received pre- or post-RP radiotherapy or hormone therapy were excluded. Kaplan-Meier method was employed for survival probability estimation. Cox regression models were used to assess bRFS differences between subsets. From 2002 to 2010, 667 eligible patients were identified. The median age was 61 yrs. (range, 43-76), with median PSA 5.6 ng/dL (0.9-28.0). At RP, most patients had pT2c (64%) disease with Gleason Score (GS) ≤6 (43%) or 7 (48%); 218 (33%) patients had positive margins (M+). At median clinical and PSA follow-up of 96 and 87 months, respectively, 146 patients (22%) experienced PSA failure with an estimated bRFS of 81%/76% at 5/8 years. For patients who underwent LND, univariable analysis identified PSA (at diagnosis), higher GS (≥7, at biopsy or RP), intermediate/high risk stratification, M+ as adversely associated with bRFS (all p < 0.01). A higher number of LNs excised was not associated with improved bRFS for the entire cohort (HR = 0.97, p = 0.27), nor for any clinical risk stratum, biopsy GS, or RP GS subgroup. This study did not demonstrate an association between LN yield and bRFS in patients with clinically localized pT2-3a/pN0 prostate cancer managed with RP alone, either in the entire population or with substratification by clinical risk stratum or GS.

Prostatic Neoplasms - pathology

Lymph Nodes - pathology

Prognosis

Follow-Up Studies

Lymph Nodes - surgery

Prostatic Neoplasms - surgery

Humans

Middle Aged

Margins of Excision

Male

Survival Rate

Lymph Node Excision - mortality

Neoplasm Recurrence, Local - mortality

Neoplasm Recurrence, Local - surgery

Prostatic Neoplasms - mortality

Neoplasm Recurrence, Local - pathology

Neoplasm Grading

Adult

Aged

Retrospective Studies

Prostatectomy - mortality

Neoplasm Staging

Details

Title: Subtitle: Is More Always Better? An Assessment of the Impact of Lymph Node Yield on Outcome for Clinically Localized Prostate Cancer with Low/Intermediate Risk Pathology (pT2-3a/pN0) Managed with Prostatectomy Alone
Creators: Steven N Seyedin - Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
Darrion L Mitchell - Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
Sarah L Mott - Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
J Kyle Russo - Bismarck Cancer Center, Bismarck, ND, USA
Chad R Tracy - Department of Urology, University of Iowa, Iowa City, IA, USA
Anthony N Snow - Department of Pathology, University of Iowa, Iowa City, IA, USA
Jessica R Parkhurst - Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
Mark C Smith - Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
John M Buatti - Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
John M Watkins - Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA. john.m.watkins.md@hotmail.com
Resource Type: Journal article
Publication Details: Pathology oncology research, Vol.25(1), pp.209-215
DOI: 10.1007/s12253-017-0349-5
PMID: 29079967
PMCID: PMC5924586
NLM abbreviation: Pathol Oncol Res
ISSN: 1219-4956
eISSN: 1532-2807
Publisher: Netherlands
Grant note: K12 CA133250 / NCI NIH HHS P30 CA086862 / NCI NIH HHS
Language: English
Date published: 01/2019
Academic Unit: Radiology; Pathology; Radiation Oncology; Urology; Neurosurgery; Otolaryngology
Record Identifier: 9984047658402771

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