Rate and Extent of Pelvic Lymph Node Dissection in the US Prostate Cancer Patients Treated With Radical Prostatectomy

Luigi Nocera; Akshay Sood; Deepansh Dalela; Philipp Gild; Craig G. Rogers; James O. Peabody; Francesco Montorsi; Mani Menon; Alberto Briganti; Firas Abdollah

doi:10.1016/j.clgc.2017.10.003

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Rate and Extent of Pelvic Lymph Node Dissection in the US Prostate Cancer Patients Treated With Radical Prostatectomy

Journal article

Peer reviewed

Rate and Extent of Pelvic Lymph Node Dissection in the US Prostate Cancer Patients Treated With Radical Prostatectomy

Luigi Nocera, Akshay Sood, Deepansh Dalela, Philipp Gild, Craig G. Rogers, James O. Peabody, Francesco Montorsi, Mani Menon, Alberto Briganti and Firas Abdollah

Clinical genitourinary cancer, Vol.16(2), pp.e451-e467

04/2018

DOI: 10.1016/j.clgc.2017.10.003

PMID: 29113771

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Abstract

We assessed the rate and extent of pelvic lymph node dissection (PLND) in US patients with prostate cancer from 2004 to 2013. Data were collected by the National Cancer Data Base and analyzed retrospectively. Surprisingly, we found that PLND use has been optimized in terms of both rate and extension, with a focus on intermediate- and high-risk patients. To evaluate the utilization of pelvic lymph node dissection (PLND) and its extent in contemporary US patients, and to correlate it to the detection of pN1 disease. A total of 328,710 individuals who received radical prostatectomy between the years 2004 and 2013 were identified within the National Cancer Data Base. The Cochran-Armitage test was used to assess the statistical significance of temporal trends. Logistic regression analysis tested the relationship between the number of lymph nodes removed (LNR) and pN1 rate. Most patients had T2 disease (76.7%) and a Gleason score of 7 (55.9%). Overall, 63.5% of the patients received PLND; this ranged between 58.9% and 72.1% over the study period (P = .8). In patients receiving PLND, mean LNR increased from 6.1 nodes in 2004 to 7.2 nodes in 2013 (P < .001). When stratified by tumor risk, utilization and extent of PLND increased in intermediate- and high-risk tumors, while it decreased in low-risk tumors. Overall pN1 rate was 3.73%, and it increased from 2.9% to 5.3% between 2004 and 2013 (P < .001). In multivariable analysis, LNR was an independent predictor of pN1 (P < .001). The utilization patterns of PLND in the United States have improved, with an increased focus on patients with intermediate- and high-risk disease. Likewise, the extent of PLND has improved to include more lymph nodes. This seems to translate into more accurate tumor, node, metastasis classification system staging, as more patients are being appropriately diagnosed with pN1 disease.

LND

Lymph nodes

PCa

Radical prostatectomy

US patients

Details

Title: Subtitle: Rate and Extent of Pelvic Lymph Node Dissection in the US Prostate Cancer Patients Treated With Radical Prostatectomy
Creators: Luigi Nocera - IRCCS Ospedale San Raffaele
Akshay Sood - Henry Ford Hospital
Deepansh Dalela - Henry Ford Hospital
Philipp Gild - Henry Ford Hospital
Craig G. Rogers - Henry Ford Hospital
James O. Peabody - Henry Ford Hospital
Francesco Montorsi - IRCCS Ospedale San Raffaele
Mani Menon - Henry Ford Hospital
Alberto Briganti - IRCCS Ospedale San Raffaele
Firas Abdollah - Henry Ford Hospital
Resource Type: Journal article
Publication Details: Clinical genitourinary cancer, Vol.16(2), pp.e451-e467
DOI: 10.1016/j.clgc.2017.10.003
PMID: 29113771
NLM abbreviation: Clin Genitourin Cancer
ISSN: 1558-7673
eISSN: 1938-0682
Publisher: Elsevier Inc
Language: English
Date published: 04/2018
Academic Unit: Urology
Record Identifier: 9984949469102771

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