Survival Outcomes of Radical Prostatectomy + Extended Pelvic Lymph Node Dissection and Radiotherapy in Prostate Cancer Patients With a Risk of Lymph Node Invasion Over 5%: A Population-Based Analysis

Junru Chen,Sha Zhu,Haoran Zhang,Jinge Zhao,Jindong Dai,Xudong Zhu,Yuchao Ni,Guangxi Sun,Pengfei Shen,Xingming Zhang,Hao Zeng,Zhipeng Wang

doi:10.3389/fonc.2020.607576

Abstract

PurposeWe aimed to compare the efficacy of radical prostatectomy (RP) + extended pelvic lymph node dissection (ePLND) and radiotherapy (RT) in localized prostate cancer (PCa) patients with a risk of lymph node invasion (LNI) over 5%.MethodsThe Surveillance, Epidemiology, and End Results (SEER) databases were used to identify patients with PCa from 2010 to 2014. Propensity score matching (PSM) was performed to balance baseline characteristics between patients in different treatment groups. Kaplan-Meier curves and Cox regression were used to assess the effects of treatments on cancer-specific survival (CSS) and overall survival (OS).ResultsOverall 20584 patients were included in this study, with 4,057 and 16,527 patients receiving RP + ePLND and RT, respectively. After PSM, patients with RP + ePLND had similar CSS (5-year CSS rate: 97.8% vs. 97.2%, P=0.310) but longer OS (5-year OS rate: 96.0% vs. 90.8%, P<0.001) compared to those receiving RT. When separating RT cohort into external beam radiotherapy (EBRT) group and EBRT+ brachytherapy (BT) group, treatments with RP + ePLND and EBRT+ BT achieved equivalent OS and were both superior to EBRT alone (5-year OS rate: 96.0% vs. 94.4% vs. 90.0%, P<0.001). Subgroup analyses and multivariate analyses further confirmed the superiority of RP + ePLND and EBRT+ BT.ConclusionRP + ePLND and EBRT + BT were associated with better survival outcomes compared to EBRT alone in PCa patients with a probability of LNI over 5%. However, no survival difference was observed between RP + ePLND and EBRT + BT.

Highlights

Prostate cancer (PCa) is the most common malignancy in men in the United States, with 191,930 estimated new cases and 33,330 estimated deaths in 2020 [1]
After propensity score matching (PSM), the baseline clinicopathologic characteristics were well balanced between the radical prostatectomy (RP) + extended pelvic lymph node dissection (ePLND) group and RT group
We found that men with a higher risk of lymph node invasion (LNI) or a Gleason score (GS)≥9 could gain more cancer-specific survival (CSS) and overall survival (OS) benefit form RP + ePLND and external beam radiotherapy (EBRT) + BT, which suggested that more intense treatments were needed in this setting

Summary

Introduction

Prostate cancer (PCa) is the most common malignancy in men in the United States, with 191,930 estimated new cases and 33,330 estimated deaths in 2020 [1]. An increasing number of patients are diagnosed as PCa at early stages with the introduction of prostate-specific antigen (PSA) screening, approximately 12% of patients still have lymph node invasion (LNI) at initial presentation [1]. It has been widely reported that the presence of positive lymph nodes represents an adverse pathologic finding associated with poor survival outcomes in patients with PCa [2,3,4]. At present, extended pelvic lymph node dissection (ePLND) represents the most accurate procedure for nodal staging and several pre-operative tools have been established to predict the individual risk of LNI in patients with PCa and select candidates for ePLND [5,6,7].

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