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Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy.

Abstract：

BACKGROUND:The presence of lymph node metastasis (LNM) at radical prostatectomy (RP) is associated with poor outcome, and optimal treatment remains undefined. An understanding of the natural history of node-positive prostate cancer (PCa) and identifying prognostic factors is needed. OBJECTIVE:To assess outcomes for patients with LNM treated with RP and lymph node dissection (LND) alone. DESIGN, SETTING, AND PARTICIPANTS:We analyzed data from a consecutive cohort of 369 men with LNM treated at a single institution from 1988 to 2010. INTERVENTION:RP and extended LND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Our primary aim was to model overall survival, PCa-specific survival, metastasis-free progression, and freedom from biochemical recurrence (BCR). We used univariate Cox proportional hazard regression models for survival outcomes. Multivariable Cox proportional hazard regression models were used for freedom from metastasis and freedom from BCR, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesical invasion, surgical margin status, and number of positive nodes as predictors. RESULTS AND LIMITATIONS:Sixty-four patients with LNM died, 37 from disease. Seventy patients developed metastasis, and 201 experienced BCR. The predicted 10-yr overall survival and cancer-specific survival were 60% (95% confidence interval [CI], 49-69) and 72% (95% CI, 61-80), respectively. The 10-yr probability of freedom from distant metastasis and freedom from BCR were 65% (95% CI, 56-73) and 28% (95% CI, 21-36), respectively. Higher pathologic Gleason score (>7 compared with ≤ 7; hazard ratio [HR]: 2.23; 95% CI, 1.64-3.04; p < 0.0001) and three or more positive lymph nodes (HR: 2.61; 95% CI, 1.81-3.76; p < 0.0001) were significantly associated with increased risk of BCR on multivariable analysis. The retrospective nature and single-center source of data are study limitations. CONCLUSIONS:A considerable subset of men with LNM remained free of disease 10 yr after RP and extended LND alone. Patients with pathologic Gleason score <8 and low nodal metastatic burden represent a favorable group. Our data confirm prior findings and support a plea for risk subclassification for patients with LNM.

journal_name

Eur Urol

journal_title

European urology

authors

Touijer KA,Mazzola CR,Sjoberg DD,Scardino PT,Eastham JA

doi

10.1016/j.eururo.2013.03.053

subject

Has Abstract

pub_date

2014-01-01 00:00:00

pages

20-5

issue

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(13)00340-0

journal_volume

pub_type

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Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy.