LBA03-02 SURVIVAL OF LYMPH-NODE-POSITIVE PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY ON DICHOTOMIZATION USING A MAXIMAL LYMPH-NODE-METASTASIS DIAMETER OF 2 MM

Abstract

You have accessJournal of UrologyCME1 Apr 2023LBA03-02 SURVIVAL OF LYMPH-NODE-POSITIVE PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY ON DICHOTOMIZATION USING A MAXIMAL LYMPH-NODE-METASTASIS DIAMETER OF 2 MM Masashi Kato, Masaki Shiota, Takahiro Kimura, Hiroshi Kitamura, and Toyonori Tsuzuki Masashi KatoMasashi Kato More articles by this author , Masaki ShiotaMasaki Shiota More articles by this author , Takahiro KimuraTakahiro Kimura More articles by this author , Hiroshi KitamuraHiroshi Kitamura More articles by this author , and Toyonori TsuzukiToyonori Tsuzuki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003426.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic lymph node (LN) dissection (PLND) during radical prostatectomy (RP) is recommended by various guidelines addressing patients with high-risk prostate cancer (PCa). Histopathological evidence of LN metastasis (LN+) is prognostic of a poor oncological outcome, although the optimal treatment for such patients remains unclear. As previously suggested for breast cancer and melanoma, the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) eighth edition describes micrometastasis as LN+ of diameter ≤ 2 mm, but supporting data are lacking. We evaluated LN+ patients’ survival after radical prostatectomy (RP) by the LN maximum tumor diameter (MTD). METHODS: We retrospectively enrolled patients pathologically diagnosed as LN+ status after PLND during RP performed without neoadjuvant therapy between 2006 and 2019 at the 33 institutions. Of 561 eligible patients, those evaluated in terms of LN+ maximum tumor diameter were included. Patients were stratified by a LN+ MTD cutoff of 2 mm, and data for 301 patients were analyzed. The outcomes included castration resistance-free survival (CRFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: In total, 301 patients were divided into two groups [LN+ MTD >2 mm (n=222) and ≤2 mm (n=79)]. The median follow-up time was 5.2 years (IQR 2.8–9.0 years). The median age was 68 years and the median PSA value at diagnosis was 14.7 ng/mL. Patients of LN+ status >2 mm exhibited significantly decreased CRFS and MFS (p<0.001 and p=0.017, respectively), and inferior CSS and OS (p=0.098 and 0.062, respectively). In patients with a PLND number ≥ 10, those of LN+ >2 mm status evidenced significantly decreased CRFS, MFS, and OS (p=0.003, 0.009, and 0.035, respectively), but for patients with a PLND number<10, there was no significant survival difference by the maximum LN+ tumor diameter. Finally, few patients of LN+ ≤ 2 mm status died from prostate cancer during follow-up. Multivariate Cox’s regression analysis showed that the PSA level at diagnosis, a biopsy Gleason pattern 5, clinical N1 stage, and LN+ >2 mm status significantly predicted CRFS. CONCLUSIONS: We found that patients of LN+ ≤2 mm status experienced more favorable outcomes after RP with a PLND number ≥10. Postoperative observation only can be considered for such patients. Our findings support the utility of the pN substaging proposed by the AJCC/UICC eighth edition, which will enable precision medicine for patients with advanced PCa. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masashi Kato More articles by this author Masaki Shiota More articles by this author Takahiro Kimura More articles by this author Hiroshi Kitamura More articles by this author Toyonori Tsuzuki More articles by this author Expand All Advertisement PDF downloadLoading ...