nach oben

International Journal of Clinical Oncology

Erschienen in:

24.04.2020 | Original Article

Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer

verfasst von: Shuichi Morizane, Masashi Honda, Ryutaro Shimizu, Shogo Teraoka, Ryoma Nishikawa, Panagiota Tsounapi, Yusuke Kimura, Hideto Iwamoto, Katsuya Hikita, Atsushi Takenaka

Erschienen in: International Journal of Clinical Oncology | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

We investigated prognostic factors for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node (LN) dissection.

Methods

We included 173 patients who underwent RARP with extended pelvic LN dissection without neoadjuvant therapy at our hospital between October 2010 and April 2018. BCR was defined as prostate serum antigen (PSA) levels ≥ 0.2 ng/mL; BCR-free survival rates were determined using Kaplan–Meier analysis. We used Cox regression analysis to evaluate effects of PSA and pathologic variables on BCR.

Results

Median follow-up was 27.9 (range 6.1–86.9) months. Five-year BCR-free survival was 89.5%. In multivariate analysis, positive LNs (HR 7.117; 95% CI 2.826–17.925; P < 0.001) and Gleason score (GS) ≥ 8 (HR 2.612; 95% CI 1.051–6.489; P = 0.039) were significant predictors of BCR. Patients with 1 or 2 positive LNs (n = 10) had significantly higher BCR-free survival rates than patients with ≥ 3 positive LNs (n = 5). We, therefore, stratified the patients as low-risk (GS < 8 and no positive LNs), intermediate-risk: (either GS ≥ 8 or positive LNs) and high-risk (both GS ≥ 8 and positive LNs). Their 1-year BCR-free survival rates were low-risk: 94.6%, intermediate-risk: 88.5%, and high-risk: 33.3% (P < 0.05).

Conclusions

Patients with 1–2 positive LNs and GS < 8 have low risk for BCR; close observation without immediate adjuvant hormonal therapy can be considered for these patients.

Novara G, Ficarra V, Mocellin S et al (2012) Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 62:382–404CrossRef

Srougi V, Bessa J Jr, Baghdadi M et al (2017) Surgical method influences specimen margins and biochemical recurrence during radical prostatectomy for high-risk prostate cancer: a systematic review and meta-analysis. World J Urol 35:1481–1488CrossRef

Fujimura T, Fukuhara H, Taguchi S et al (2017) Robot-assisted radical prostatectomy significantly reduced biochemical recurrence compared to retro pubic radical prostatectomy. BMC Cancer 17:454CrossRef

Thompson JE, Egger S, Bohm M et al (2014) Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. Eur Urol 65:521–531CrossRef

Koo KC, Jung DC, Lee SH et al (2014) Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged %3e/=70 years. Prostate Int 2:127–132CrossRef

Boorjian SA, Thompson RH, Siddiqui S et al (2007) Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol 178:864–870 (discussion 70–71)

Masterson TA, Bianco FJ Jr, Vickers AJ et al (2006) The association between total and positive lymph node counts, and disease progression in clinically localized prostate cancer. J Urol 175:1320–1324 (discussion 4–5)

Briganti A, Blute ML, Eastham JH et al (2009) Pelvic lymph node dissection in prostate cancer. Eur Urol 55:1251–1265CrossRef

Gandaglia G, De Lorenzis E, Novara G et al (2017) Robot-assisted radical prostatectomy and extended pelvic lymph node dissection in patients with locally-advanced prostate cancer. Eur Urol 71:249–256CrossRef

10.

Fossati N, Willemse PM, Van den Broeck T et al (2017) The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol 72:84–109CrossRef

11.

Preisser F, van den Bergh RCN, Gandaglia G et al (2020) Effect of extended pelvic lymph node dissection on oncologic outcomes in patients with D'Amico intermediate and high risk prostate cancer treated with radical prostatectomy: a multi-institutional study. J Urol 203:338–343CrossRef

12.

Heidenreich A, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71

13.

Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 71: 618–629

14.

Kim DK, Koo KC, Abdel Raheem A et al (2016) Single positive lymph node prostate cancer can be treated surgically without recurrence. PLoS ONE 11:e0152391CrossRef

15.

Briganti A, Karnes JR, Da Pozzo LF et al (2009) Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 55:261–270

16.

Touijer KA, Mazzola CR, Sjoberg DD, Scardino PT, Eastham JA (2014) Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy. Eur Urol 65:20–25CrossRef

17.

Bader P, Burkhard FC, Markwalder R et al (2003) Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 169:849–854

18.

Morizane S, Honda M, Fukasawa S et al (2018) Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot-assisted radical prostatectomy: a multi-institutional retrospective study in Japan. Int J Clin Oncol 23:568–575CrossRef

19.

Mohler J, Bahnson RR, Boston B et al (2010) NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Cancer Netw 8:162–200CrossRef

20.

Ploussard G, Briganti A, de la Taille A et al (2014) Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 65:7–16CrossRef

21.

Palapattu GS, Allaf ME, Trock BJ et al (2004) Prostate specific antigen progression in men with lymph node metastases following radical prostatectomy: results of long-term followup. J Urol 172:1860–1864CrossRef

22.

Liesenfeld L, Kron M, Gschwend JE et al (2017) Prognostic factors for biochemical recurrence more than 10 years after radical prostatectomy. J Urol 197:143–148CrossRef

23.

Badani KK, Reddy BN, Moskowitz EJ et al (2018) Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesicle invasion and node-negative disease. Urol Oncol 36(310):e1–e6

24.

Poelaert F, Joniau S, Roumeguere T et al (2019) Current management of pT3b prostate cancer after robot-assisted laparoscopic prostatectomy. Eur Urol Oncol 2:110–117CrossRef

25.

Tosco L, Laenen A, Briganti A et al (2018) The EMPaCT classifier: a validated tool to predict postoperative prostate cancer-related death using competing-risk analysis. Eur Urol Focus 4:369–375CrossRef

26.

Messing EM, Manola J, Yao J et al (2006) Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 7:472–479CrossRef

27.

Seiler R, Studer UE, Tschan K et al (2014) Removal of limited nodal disease in patients undergoing radical prostatectomy: long-term results confirm a chance for cure. J Urol 191:1280–1285CrossRef

28.

Schumacher MC, Burkhard FC, Thalmann GN et al (2008) Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol 54:344–352CrossRef

29.

Abdollah F, Gandaglia G, Suardi N et al (2015) More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 67:212–219CrossRef

30.

Abdollah F, Sun M, Thuret R et al (2012) Lymph node count threshold for optimal pelvic lymph node staging in prostate cancer. Int J Urol 19:645–651CrossRef

31.

Mattei A, Fuechsel FG, Bhatta Dhar N et al (2008) The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 53:118–125CrossRef

32.

Wilczak W, Wittmer C, Clauditz T et al (2018) Marked prognostic impact of minimal lymphatic tumor spread in prostate cancer. Eur Urol 74:376–386CrossRef

Titel: Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer
verfasst von: Shuichi Morizane
Masashi Honda
Ryutaro Shimizu
Shogo Teraoka
Ryoma Nishikawa
Panagiota Tsounapi
Yusuke Kimura
Hideto Iwamoto
Katsuya Hikita
Atsushi Takenaka
Publikationsdatum: 24.04.2020
Verlag: Springer Singapore
Erschienen in: International Journal of Clinical Oncology / Ausgabe 7/2020
Print ISSN: 1341-9625
Elektronische ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-020-01682-1

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer