Abstract
Pelvic lymph node dissection (PLND) represents the gold standard for nodal staging in PCa and is recommended for patients with a probability of lymph node invasion (LNI) >5%. However, the therapeutic role of PLND and its extent remains a debate. In this study, data of 20,668 patients treated with radical prostatectomy (RP) with and without PLND from SEER database between 2010 and 2015 were retrospectively analyzed. All patients had a risk of LNI >5% according to 2012-Briganti nomogram. Propensity score matching (PSM) was performed to balance baseline characteristics between patients with and without PLND. Kaplan-Meier curves and Cox regression were used to evaluate the impacts of the PLND and its extent on cancer-specific survival (CSS) and overall survival (OS). In overall cohort, patients with PLND were associated with more aggressive clinicopathologic characteristics and had poorer survival compared to those without PLND (5-year CSS rate: 98.4% vs. 99.7%, p < 0.001; 5-year OS rate: 96.3% vs. 97.8%, p < 0.001). In the post-PSM cohort, no significant difference in survival was found between patients with and without PLND (5-year CSS rate: 99.4% vs. 99.7%, p = 0.479; 5-year OS rate: 97.3% vs. 97.8%, p = 0.204). In addition, the extent of PLND had no impact on prognosis (all p > 0.05). Subgroup analyses reported similar negative findings. In conclusion, neither PLND nor its extent was associated with survival in North American patients with a risk of LNI >5%. The cut-off point of 5% probability of LNI might be too low to show benefits in survival in patients underwent PLND.
Highlights
Pelvic lymph node dissection (PLND) represents the gold standard for nodal staging in prostate cancer (PCa) and is recommended for patients with a probability of lymph node invasion (LNI) >5%
According to European Association of Urology (EAU) guidelines, PLND is recommended for patients with a probability of LNI over 5% based on 2012-Briganti nomogram[2,7]
We aimed to investigate the therapeutic role of PLND and its extent in North American patients with a risk of LNI >5%
Summary
Pelvic lymph node dissection (PLND) represents the gold standard for nodal staging in PCa and is recommended for patients with a probability of lymph node invasion (LNI) >5%. Neither PLND nor its extent was associated with survival in North American patients with a risk of LNI >5%. Despite the essential role of PLND in PCa staging, its therapeutic value is still obscure[3] It is associated with higher risk of perioperative complications such as increased blood loss, lymphoceles and thromboembolic events[4,5]. With the improved PCa imaging and multimodal treatment approaches, it is of great necessity to comprehensively evaluate the survival benefit of PLND in patients with localized PCa. In the present study, we aimed to investigate the therapeutic role of PLND and its extent in North American patients with a risk of LNI >5%
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