Prognostic Impact of Lymphatic Invasion in Patients with High-Risk Prostate Cancer after Robot-Assisted Radical Prostatectomy and Extended Lymph Node Dissection: A Single-Institution Prospective Cohort Study.

Abstract

Simple SummaryThe aim of our prospective cohort study was to assess the impact of lymphatic invasion on biochemical recurrence (BCR) in patients who underwent robot-assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND) for high-risk prostate cancer (PC). Of 183 patients, lymphatic invasion and lymph node metastasis were observed in 47 (26%) and 17 patients (9%), respectively, whereas BCR was observed in 48 patients (26%). The BCR rate was significantly higher in patients with lymphatic invasion than in patients without lymphatic invasion. Moreover, according to multivariable analyses, lymphatic invasion was an independent significant predictor of BCR in the overall patient group and in patients without lymph node metastasis. Evaluation of lymphatic invasion could therefore be a useful predictor of BCR in patients who have undergone RARP and eLND for high-risk PC.The prognostic impact of lymphatic invasion in patients with high-risk prostate cancer (PC) remains unclear. The aim of our single-institution prospective cohort study was to examine the impact of lymphatic invasion on biochemical recurrence (BCR) in patients with high-risk PC according to National Comprehensive Cancer Network (NCCN) criteria who underwent robot-assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND). A total of 183 patients were included who underwent RARP and eLND for NCCN high-risk PC between June 2014 and August 2019. Lymphatic invasion in resected specimens was observed in 47 patients (26%), whereas lymph node metastasis was observed in 17 patients (9%). During follow-up, BCR was observed in 48 patients (26%). The BCR rate in patients with lymphatic invasion was significantly higher than that in patients without lymphatic invasion (p < 0.01). According to multivariable Cox proportional hazards regression analyses, lymphatic invasion was a significant independent predictor of BCR in the overall patient group and was independently associated with BCR, even in patients without lymph node metastasis. In conclusion, evaluation of lymphatic invasion could be useful in predicting BCR in patients undergoing RARP and eLND for high-risk PC.