Need For Pelvic Lymph Node Dissection Research Articles

Influence of Biopsy Gleason Score on the Risk of Lymph Node Invasion in Patients With Intermediate-Risk Prostate Cancer Undergoing Radical Prostatectomy.

Objective: To analyze the influence of biopsy Gleason score on the risk for lymph node invasion (LNI) during pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy (RP) for intermediate-risk prostate cancer (PCa).Materials and Methods: We retrospectively analyzed 684 patients, who underwent RP between 2014 and June 2020 due to PCa. Univariable and multivariable logistic regression, as well as binary regression tree models were used to assess the risk of positive LNI and evaluate the need of PLND in men with intermediate-risk PCa.Results: Of the 672 eligible patients with RP, 80 (11.9%) men harbored low-risk, 32 (4.8%) intermediate-risk with international society of urologic pathologists grade (ISUP) 1 (IR-ISUP1), 215 (32.0%) intermediate-risk with ISUP 2 (IR-ISUP2), 99 (14.7%) intermediate-risk with ISUP 3 (IR-ISUP3), and 246 (36.6%) high-risk PCa. Proportions of LNI were 0, 3.1, 3.7, 5.1, and 24.0% for low-risk, IR-ISUP1, IR-ISUP 2, IR-ISUP-3, and high-risk PCa, respectively (p < 0.001). In multivariable analyses, after adjustment for patient and surgical characteristics, IR-ISUP1 [hazard ratio (HR) 0.10, p = 0.03], IR-ISUP2 (HR 0.09, p < 0.001), and IR-ISUP3 (HR 0.18, p < 0.001) were independent predictors for lower risk of LNI, compared with men with high-risk PCa disease.Conclusions: The international society of urologic pathologists grade significantly influence the risk of LNI in patients with intermediate- risk PCa. The risk of LNI only exceeds 5% in men with IR-ISUP3 PCa. In consequence, the need for PLND in selected patients with IR-ISUP 1 or IR-ISUP2 PCa should be critically discussed.

Abstract 3920: Tumor volume as a predictor of lymph node metastases in prostate cancer

Abstract Introduction: Pelvic lymph node dissection (PLND) is recommended during radical prostatectomy (RP) in patients with high risk prostate cancer (PCa). Guidelines recommend extended PLND in patients who have &amp;gt;5% probability of lymph node involvement, calculated from pre-operative parameters. PLND increases procedure time and potential morbidity to patients. Tumour size has been reported to be predictive of biochemical recurrence after RP. We analysed the utility of several parameters including tumour size in predicting lymph node metastases in order to further refine the population who require PLND during RP. Materials &amp; Methods: We maintained a prospective database of Robotic Assisted Radical Prostatectomy (RARP) from July 2012 to August 2016 consisting of a cohort of 531 patients. Patients with &amp;gt;5% calculated probability of lymph node metastasis had PLND during RARP. We performed multiple linear regression using age, PSA, D’Amico risk score, ISUP prognostic group, clinical T-stage, radiological T-stage, tumour volume, tumour volume relative to prostate size (relative tumour volume), and number of nodes excised during PLND to determine if any of these parameters could predict the presence of lymph node metastases. Results: Of the cohort of 531 patients, 154 had PLND during RARP. Of the PLND cohort, 15 (10%) had pN1 disease. Tumour volume (r2 0.044, p= 0.0098), relative tumour volume (r2 0.033, p=0.026) and number of lymph nodes excised (r2 0.046, p=0.0075) were independent predictors of pN1 disease. D’Amico risk score (r2 0.019, p=0.089) approached but did not reach statistical significance. Patients with pN1 disease all had primary tumours ≥6cc. Conclusions: In our cohort of PLND patients, tumour volume was an independent risk factor for pN1 disease. With the increasing availability of multi-parametric MRI, tumour volume can be measured pre-operatively as an adjunct to PIRADS scoring. The role of tumour volume and relative tumour volume in predicting lymph node metastasis in conjunction with other pre-operative parameters requires further investigation. The use of tumour volume in determining the need for PLND in patients undergoing RP may help to further refine the population at highest risk for pN1 disease and avoid the additional morbidity of PLND in those at low risk. In addition, our findings support the recommendation of performing an extended PLND to maximise regional lymph node clearance. Citation Format: Chidi N. Molokwu, Keith Yuen, Sanjay Addla, Rajindra Singh, Rohit Chahal. Tumor volume as a predictor of lymph node metastases in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3920. doi:10.1158/1538-7445.AM2017-3920

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

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 ...

393 THE NUMBER OF PELVIC LYMPH NODES REMOVED AT RADICAL RETROPUBIC PROSTATECTOMY AFFECTS THE RATE OF NODAL INVOLVEMENT IN ALL RISK CATEGORIES OF PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010393 THE NUMBER OF PELVIC LYMPH NODES REMOVED AT RADICAL RETROPUBIC PROSTATECTOMY AFFECTS THE RATE OF NODAL INVOLVEMENT IN ALL RISK CATEGORIES OF PROSTATE CANCER Giuseppe Campo, Cesare Selli, Chiara Mariani, Paolo Casale, Michele Andreuccetti, Giorgio Pomara, and Francesco Francesca Giuseppe CampoGiuseppe Campo More articles by this author , Cesare SelliCesare Selli More articles by this author , Chiara MarianiChiara Mariani More articles by this author , Paolo CasalePaolo Casale More articles by this author , Michele AndreuccettiMichele Andreuccetti More articles by this author , Giorgio PomaraGiorgio Pomara More articles by this author , and Francesco FrancescaFrancesco Francesca More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.462AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa). The need for PLND has been questioned in patients with low risk tumors, due to the negligible rate of lymph node involvement (LNI) in such group. The purpose of this study was to evaluate the association between the number of lymph nodes removed with the presence of LNI in patients with low, intermediate and high risk PCa. METHODS The study cohort included 1131 consecutive patients treated with radical retropubic prostatectomy (RRP) and PLND for clinically localized prostate cancer. Patients were divided into three groups according to the number of lymph nodes removed (LnR): ≤ 9 LnR, 10-19 LnR, ≥20 LnR and into three risk groups: low risk (T1c, PSA<10 ng/ml and biopsy Gleason sum ≤6), high risk (PSA>20 ng/ml or cT3 or biopsy Gleason sum ≥8) and intermediate risk (all the remaining). The probability of finding LNI according to the number of removed lymph nodes and for each risk group was analyzed RESULTS Overall, 423 (37.4%), 588 (52%) and 120 (10.6%) patients had low, intermediate and high risk prostate cancer, respectively. 351 (31%), 509 (45%) and 271 (24%) patients had ≤ 9 LnR, 10-19 LnR, ≥20 LnR respectively. Mean PSA was 11.8 ng/ml (Range 0.34-220). Biopsy Gleason sum was 2-6, 7 and 8-10 in 450 (39.8%), 559 (49.4%), 122 (10.8%) of patients. Overall, 98 (9%) patients had LNI, which was found in 4.5%, 10.5% and 14.2% of patients with low, intermediate and high risk prostate cancer, respectively (p<0.0001). LNI was found in 5.1%, 7.5% and 15.5% of patients with ≤ 9 LnR, 10-19 LnR, ≥20 LnR, respectively (p<0.0004). Overall, a mean of 14.2 lymph nodes were removed and examined. The mean number of nodes removed did not differ among the different risk groups (13.9, 14.2 and 14.9 in low, intermediate and high risk groups, respectively; p=ns).The removal of 20 lymph nodes or more yielded a significant increase of LNI detection: 11.2%, 15.7% and 27.7% in patients with low, intermediate and high risk prostate cancer, respectively. On the other hand, assessment of 9 or fewer nodes was associated with a significant reduction of finding LNI in all risk categories: 0 %, 9.1% and 8.8 % (low, intermediate and high risk prostate cancer, respectively). CONCLUSIONS The number of lymph nodes surgically removed is significantly associated with the presence of LNI in patients with low, intermediate and high risk prostate cancer. Therefore, if a staging PLND is contemplated, this should be extended, even in the low risk group Pisa, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e156 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Campo More articles by this author Cesare Selli More articles by this author Chiara Mariani More articles by this author Paolo Casale More articles by this author Michele Andreuccetti More articles by this author Giorgio Pomara More articles by this author Francesco Francesca More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Commentary on Pelvic Lymph Node Dissection in Prostate Cancer: Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, Montorsi F, Studer UE, Department of Urology, Vita-Salute University, Milan, Italy

Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa); however, the therapeutic benefit of PLND in PCa management is currently under debate. To systematically review the available literature concerning the role of PLND and its extent in PCa staging and outcome. All of the existing recommendations and staging tools determining the need for PLND were also assessed. Moreover, a systematic review was performed of the long-term outcome of node-positive patients stratified according to the extent of nodal invasion. A Medline search was conducted to identify original and review articles as well as editorials addressing the significance of PLND in PCa. Keywords included prostate cancer, pelvic lymph node dissection, radical prostatectomy, imaging, and complications. Data from the selected studies focusing on the role of PLND in PCa staging, and outcome were reviewed and discussed by all of the contributing authors. Despite recent advances in imaging techniques, PLND remains the most accurate staging procedure for the detection of lymph node invasion (LNI) in PCa. The rate of LNI increases with the extent of PLND. Extended PLND (ePLND; i.e., removal of obturator, external iliac, hypogastric with or without presacral, and common iliac nodes) significantly improves the detection of lymph node metastases compared with limited PLND (lPLND; i.e., removal of obturator with or without external iliac nodes), which is associated with poor staging accuracy. Because not all patients with PCa are at the same risk of harboring nodal metastases, several nomograms and tables have been developed and validated to identify candidates for PLND. These tools, however, are based mostly on findings derived from lPLND dissections performed in older patient series. According to these prediction models, a staging PLND might be omitted in low-risk PCa patients because of the low rate of lymph node metastases found, even after extended dissections (<8%). The outcome for patients with positive nodes is not necessarily poor. Indeed, patients with low-volume nodal metastases experience excellent survival rates, regardless of adjuvant treatment. But despite few retrospective studies reporting an association between PLND and PCa progression and survival, the exact impact of PLND on patient outcomes has not yet been clearly proven because of the lack of prospective randomized trials. On the basis of current data, we suggest that if a PLND is indicated, then it should be extended. Conversely, in view of the low rate of LNI among patients with low-risk PCa, a staging ePLND might be spared in this patient category. Whether this approach is also safe from oncologic perspectives is still unknown. Patients with low-volume nodal metastases have a good long-term prognosis; to what extent this prognosis is the result of a positive impact of PLND on PCa outcomes is still to be determined.