MP11-04 THE IMPORTANCE OF THE SIZE OF NODAL METASTASES IN PREDICTING RECURRENCE OF NODE POSITIVE PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION: IMPLICATIONS FOR POST-OPERATIVE TREATMENT TAILORING

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2018MP11-04 THE IMPORTANCE OF THE SIZE OF NODAL METASTASES IN PREDICTING RECURRENCE OF NODE POSITIVE PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION: IMPLICATIONS FOR POST-OPERATIVE TREATMENT TAILORING Elio Mazzone, Giorgio Gandaglia, Nicola Fossati, Paolo Dell'Oglio, Nazareno Suardi, Emanuele Zaffuto, Massimo Freschi, Roberta Lucianó, Alessandro Larcher, Vincenzo Mirone, Renzo Colombo, Franco Gaboardi, Francesco Montorsi, and Alberto Briganti Elio MazzoneElio Mazzone More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Roberta LucianóRoberta Lucianó More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , Franco GaboardiFranco Gaboardi More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.370AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Not all patients with node positive prostate cancer (PCa) are affected by a poor prognosis, where men with ≤2 positive nodes have favourable outcomes compared to their counterparts with higher number of positive nodes. However, none of the current models considered the size of nodal metastases. We sought to develop a prediction model including the diameter of nodal metastases to improve our ability to stratify patients with lymph node invasion METHODS Overall, 255 node positive PCa patients treated with RP and nodal dissection between 2011 and 2017 at a single center were identified. All patients had detailed data on the number of nodes removed, the number of positive nodes and the maximum diameter of nodal metastasis. Clinical recurrence (CR) was defined as positive imaging during follow-up after the onset of biochemical recurrence. Multivariable Cox regression analyses tested the impact of maximum nodal involvement on CR after adjusting for pathologic characteristics. The accuracy of the model was quantified using the ROC-derived area under the curve (AUC) and was compared to a model that included the number of positive nodes only. Kaplan-Meier analyses assessed time to CR after stratifying patients according to the number of positive nodes (≤2 vs >2) and maximum nodal involvement strati ed according to the median diameter (≤5 vs >5 mm). RESULTS The median number of nodes removed and of positive nodes were 21 and 2. Median maximum nodal involvement was 5 mm. Overall, 179 (70.2%) and 105 (41.2%) patients had pT3b/4 and ISUP grade group 4-5 disease. Overall, 25 patients experienced CR. At multivariable analyses, the maximum diameter of nodal involvement represented a predictor of CR (Hazard ratio [HR]: 1.04; p=0.01). The multivariable model including the maximum diameter of nodal involvement had a higher AUC as compared to a model based only on the number of positive nodes (73 vs 65%). The 5-year CR-free survival rates were 92.5% vs 87.4% vs 71.6% vs 67.6% for ≤2 positive nodes and ≤5 mm diameter vs ≤2 positive nodes >5 mm diameter vs >2 positive nodes ≤5 mm diameter vs >2 positive nodes >5 mm diameter (p=0.001). CONCLUSIONS The maximum dimension of nodal invasion represents a predictor of CR and should be considered to identify node positive patients at higher risk of recurrence. A model based on the number of positive nodes and maximum nodal involvement can be used to identify candidates for additional cancer therapies after surgery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e128 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Paolo Dell'Oglio More articles by this author Nazareno Suardi More articles by this author Emanuele Zaffuto More articles by this author Massimo Freschi More articles by this author Roberta Lucianó More articles by this author Alessandro Larcher More articles by this author Vincenzo Mirone More articles by this author Renzo Colombo More articles by this author Franco Gaboardi More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...