The online version of this article (doi:10.1186/s12894-015-0070-1) contains supplementary material, which is available to authorized users.
Young Suk Kwon and Yun-Sok Ha contributed equally to this work.
None of the contributing authors have any conflicts of interest, including specific financial interests and relationships and affiliation relevant to the subject matter or materials discussed in the manuscript.
YSK and YSH reviewed the pertinent literature, analyzed the results, and drafted and edited the manuscript. IYK was responsible for the entire project. He designed the study concept, guided the study design, conducted data acquisition, and revised the manuscript critically for important intellectual content. PKM, AS, JSP, NP, IF, MM, DIL, EL, TP, KHR, TA, DS, HA, SKC, SP, SSJ, YCO, DE, VM, DA, KB, BY, NR, THK, TGK, DM, JH, and WJK collected data, analyzed data, and revised the manuscript. All authors read and approved the final manuscript.
The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population.
Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR).
Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8–10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP.
There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480–7. CrossRefPubMed
Briganti A, Abdollah F, Nini A, Suardi N, Gallina A, Capitanio U, et al. Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol. 2012;61(6):1132–8. CrossRefPubMed
- Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institution international study
Young Suk Kwon
Parth K. Modi
Jaspreet S. Parihar
David I. Lee
Koon Ho Rha
Seong Soo Jeon
Tae Gyun Kwon
Isaac Yi Kim
- BioMed Central
Neu im Fachgebiet Urologie
Meistgelesene Bücher in der Urologie
Mail Icon II