You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2012772 PREDICTORS OF LONG-TERM SURVIVAL OF PATIENTS WITH HIGH VOLUME OF NODAL METASTASES AT EXTENDED PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER. THE IMPORTANCE OF AN INTEGRATED, MULTIMODAL APPROACH Nazareno Suardi, Alberto Briganti, Andrea Gallina, Firas Abdollah, Lorenzo Rocchini, Giorgio Gandaglia, Marco Moschini, Nicola Fossati, Niccolò Passoni, Paolo Capogrosso, Massimo Freschi, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Lorenzo RocchiniLorenzo Rocchini Milan, Italy More articles by this author , Giorgio GandagliaGiorgio Gandaglia Milan, Italy More articles by this author , Marco MoschiniMarco Moschini Milan, Italy More articles by this author , Nicola FossatiNicola Fossati Milan, Italy More articles by this author , Niccolò PassoniNiccolò Passoni Milan, Italy More articles by this author , Paolo CapogrossoPaolo Capogrosso Milan, Italy More articles by this author , Massimo FreschiMassimo Freschi Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.859AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have shown excellent outcome for patients with low number of positive lymph nodes (LNs) at extended pelvic lymph node dissection (ePLND). However, none of them evaluated predictors of survival of patients with high volume of nodal burden. METHODS We evaluated 779 with positive LNs treated with radical prostatectomy (RP) and ePLND between January 1991 and February 2011 at single tertiary care center. Of these, 232 (29.7%) had ≥3 positive LNs and represented the study cohort. Univariable and multivariable Cox regression analyses tested the relationship between pathological tumor characteristics, including number of positive nodes (NPN), pathological stage, primary and secondary pathological Gleason score, adjuvant treatment status and cancer specific survival(CSS). Restricted cubic spline was used to test the linearity assumption of continuously coded variable. RESULTS The average number of LNs removed was 21.2 (median: 19.0, range: 10-59). Average NPN was 5.6 nodes (median: 4, range: 3-15). Mean time to CSS was 149.3 months (median: not reached). Overall survival was 72, 66, and 60% at 5, 8 and 10-year follow-up, respectively. Cancer specific survival was 78, 72, and 66% at 5, 8 and 10-year follow-up, respectively. At multivariable analysis, the NPN was the strongest predictor of CSS (hazard ratio [HR]: 1.3, p=0.02). Interestingly, the effect of NPN on CSS was linear without reaching any plateau. Finally, adjuvant radiotherapy (HR: 0.02, p=0.02) and adjuvant hormonal therapy (HR: 0.04, p=0.009) also demonstrated to be significantly inversely associated with prostate cancer death. CONCLUSIONS The outcome of patients with high-volume of LN invasion (namely ≥ 3 positive LNs) is not invariably poor (66% at 10 year follow-up). Long term survival is linearly correlated with the number of positive LNs. Moreover, adjuvant radiotherapy and hormonal therapy also represented significant predictors of patient survival. These data support the need for an integrated, extensive multimodal approach in these patients in order to maximize cancer control and increase long-term survival. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e315 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nazareno Suardi Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Lorenzo Rocchini Milan, Italy More articles by this author Giorgio Gandaglia Milan, Italy More articles by this author Marco Moschini Milan, Italy More articles by this author Nicola Fossati Milan, Italy More articles by this author Niccolò Passoni Milan, Italy More articles by this author Paolo Capogrosso Milan, Italy More articles by this author Massimo Freschi Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...