PD15-09 PELVIC LYMPH NODE DISSECTION CAN BE SAFELY OMITTED IN MEN WITH A RISK OF NODAL METASTASES ≤5% BASED ON THE BRIGANTI NOMOGRAM: VALIDATION OF THE EAU GUIDELINS RECCOMENDATIONS FOR NODAL DISSECTION BASED ON PATIENT OUTCOME

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You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2014PD15-09 PELVIC LYMPH NODE DISSECTION CAN BE SAFELY OMITTED IN MEN WITH A RISK OF NODAL METASTASES ≤5% BASED ON THE BRIGANTI NOMOGRAM: VALIDATION OF THE EAU GUIDELINS RECCOMENDATIONS FOR NODAL DISSECTION BASED ON PATIENT OUTCOME Firas Abdollah, Andrea Gallina, Marco Bianchi, Nazareno Suardi, Ettore Di Trapani, Paolo Dell'Oglio, Valerio Di Girolamo, Alessandro Nini, Umberto Capitanio, Pierre I. Karakiewicz, Maxine Sun, Shahrokh F. Shariat, Francesco Montorsi, and Alberto Briganti Firas AbdollahFiras Abdollah More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Ettore Di TrapaniEttore Di Trapani More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Valerio Di GirolamoValerio Di Girolamo More articles by this author , Alessandro NiniAlessandro Nini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Maxine SunMaxine Sun More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat 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.2014.02.1298AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The updated EAU guidelines recommendations on the need for pelvic lymph node dissection (PLND) in prostate cancer indicate to omit PLND in all men with a risk of lymph node invasion (LNI) ≤5% based on the updated Briganti nomogram. Such recommendations have been given based on previous staging studies. However, whether PLND and its extent have no impact on cancer control in these patients with limited LNI risk has not been proven yet. METHODS This study included 1406 patients treated with radical prostatectomy with or without anatomically extended pelvic lymph node dissection (PLND), between 1999 and 2012. All patients had a lymph node invasion (LNI) predicted probability ≤5% according to the Briganti nomogram. All had complete clinical and follow-up data. Kaplan-Meier curves assessed the time to BCR, defined as two subsequent prostate-specific antigen values of 0.2 ng/ml or higher. Cox regression tested the relationship between PLND status and biochemical recurrence (BCR) in the overall population. Likewise, Cox regression tested the relationship between the number of removed nodes and BCR in patients treated with PLND. Multivariable analyses were adjusted for all confounders, such as PSA, clinical stage, biopsy Gleason sum and percentage of positive cores . RESULTS Mean patients age was 65.1 years (median: 66.0, range: 44.0-80.0). Mean and median follow-up times were 46.6 and 39.0 months, respectively. Most patients (87.7%) received PLND. Among these, the mean number of removed nodes was 15.1 (median: 14.0, range: 8-52). Overall, the 5- and 7-years BCR rates were 93.2% and 87.1%, respectively. These rates were respectively 90.6% and 90.6% in patients treated without PLND vs. 93.3% and 86.9% in patients treated with PLND (p=0.9). At multivariable analysis, PLND status was not a significant predictor of BCR risk (hazard ratio [HR]: 0.69, p=0.4). In patients treated with PLND, the number of removed nodes was not an independent predictor of BCR risk at univariable (HR: 1.00, p=0.9) and multivariable analyses (HR: 1.00, p=0.7). CONCLUSIONS We report the first validation of the EAU guidelines recommendation on the need for PLND in prostate cancer based on post-operative patient outcome. Neither PLND nor its extent was significantly associated with improved cancer control in men with a LNI risk ≤5% according to the Briganti nomogram. Therefore, a PLND can be safely omitted in these patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e419 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Firas Abdollah More articles by this author Andrea Gallina More articles by this author Marco Bianchi More articles by this author Nazareno Suardi More articles by this author Ettore Di Trapani More articles by this author Paolo Dell'Oglio More articles by this author Valerio Di Girolamo More articles by this author Alessandro Nini More articles by this author Umberto Capitanio More articles by this author Pierre I. Karakiewicz More articles by this author Maxine Sun More articles by this author Shahrokh F. Shariat 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 ...