Abstract
PurposeThe therapeutic effect of extended pelvic lymph node dissection (PLND) in prostate cancer (PCa) patients is still controversial. The aim of this study was to identify the PCa patients who may benefit from extended PLND based on the 2012 Briganti nomogram.Materials and MethodsPCa patients who underwent radical prostatectomy (RP) plus PLND between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The probability of lymph node invasion (LNI), determined using the 2012 Briganti nomogram, was used to stratify the patients. The endpoints were overall survival (OS) and cancer-specific survival (CSS). Propensity score matching (PSM) was performed to account for potential differences between patients with and without extended PLND. Univariable and multivariable Cox regression was used to analyze the association between the number of removed nodes (NRN) and survival. Kaplan–Meier analysis was performed to estimate OS and CSS. Extended PLND was defined as NRN >75th percentile.ResultsA total of 27,690 patients were included in the study. NRN was not an independent predictor of OS (p = 0.564). However, in patients with probability of LNI ≥37, multivariable analyses showed that increased NRN was associated with improved OS (hazard ratio [HR] = 0.963; p = 0.002). The 5-y OS rate was significantly higher for patients with NRN ≥12 than those with NRN <12 (94.9% vs. 91.9%, respectively; p = 0.015). In the PSM cohort, among patients with probability of LNI ≥37, multivariable analyses showed that increased NRN was associated with improved OS (HR = 0.961; p = 0.004). In addition, the 5-y OS rate was significantly higher for patients with NRN ≥12 than those with NRN <12 (94.9% vs. 89.8%, respectively; p = 0.002). However, NRN was not an independent predictor of CSS in any LNI risk subgroup (all p >0.05).ConclusionExtensive PLND might be associated with improved survival in PCa patients with a high risk of LNI, which supports the use of extended PLND in highly selected PCa patients. The results need to be validated in prospective studies with long-term follow-up.
Highlights
Current imaging techniques have low sensitivity for detecting lymph node metastasis in prostate cancer (PCa) patients
0.143 0.209 0.134 0.052 0.015
Previous studies reported that the risk groups based on preoperative prostate-specific antigen (PSA) level, biopsy Gleason score, and clinical stage did not accurately select PCa patients who may benefit from extended PLND [6, 10, 11]
Summary
Current imaging techniques have low sensitivity for detecting lymph node metastasis in prostate cancer (PCa) patients. The therapeutic benefit associated with extended PLND should be tested in subgroups of PCa patients. Novel prediction models, imaging techniques, molecular classification, and artificial intelligence have high accuracy in detecting lymph node metastasis and may identify patients suitable for extended PLND [2, 16,17,18]. The novel system will lead to an increase in the consensus in radiological assessment of lymph nodes in PCa patients and may be used to select suitable patients for extended PLND. Several studies have suggested that the LNI cutoff of 5% may be too low to demonstrate a therapeutic benefit of extended PLND [11, 23, 24]
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