Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion

F Preisser, Marco Bandini, Michele Marchioni, S Nazzani, Z Tian, RS Pompe, Nicola Fossati, A Briganti, F Saad, SF Shariat, H Heinzer, H Huland, M Graefen, D Tilki, PI Karakiewicz

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP). Methods: Within the Surveillance, Epidemiology, and End results (SEER) database (2004–2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN. Results: In 28 147 RP and PLND patients without LNI, 67.3% versus 32.7% exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1%), GS ≥8 (25.7 vs 22.4%), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1%). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1% for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5%. Conclusion: More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals. © 2018 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)469-475
Number of pages7
JournalProstate
Volume78
Issue number6
DOIs
Publication statusPublished - 2018

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Prostatectomy
Lymph Node Excision
Prostatic Neoplasms
Lymph Nodes
Survival
Logistic Models
Mortality
Neoplasms
Kaplan-Meier Estimate
Survival Analysis
Proportional Hazards Models
Epidemiology
Databases
Biopsy

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Preisser, F., Bandini, M., Marchioni, M., Nazzani, S., Tian, Z., Pompe, RS., ... Karakiewicz, PI. (2018). Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. Prostate, 78(6), 469-475. https://doi.org/10.1002/pros.23491

Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. / Preisser, F; Bandini, Marco; Marchioni, Michele; Nazzani, S; Tian, Z; Pompe, RS; Fossati, Nicola; Briganti, A; Saad, F; Shariat, SF; Heinzer, H; Huland, H; Graefen, M; Tilki, D; Karakiewicz, PI.

In: Prostate, Vol. 78, No. 6, 2018, p. 469-475.

Research output: Contribution to journalArticle

Preisser, F, Bandini, M, Marchioni, M, Nazzani, S, Tian, Z, Pompe, RS, Fossati, N, Briganti, A, Saad, F, Shariat, SF, Heinzer, H, Huland, H, Graefen, M, Tilki, D & Karakiewicz, PI 2018, 'Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion', Prostate, vol. 78, no. 6, pp. 469-475. https://doi.org/10.1002/pros.23491
Preisser, F ; Bandini, Marco ; Marchioni, Michele ; Nazzani, S ; Tian, Z ; Pompe, RS ; Fossati, Nicola ; Briganti, A ; Saad, F ; Shariat, SF ; Heinzer, H ; Huland, H ; Graefen, M ; Tilki, D ; Karakiewicz, PI. / Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. In: Prostate. 2018 ; Vol. 78, No. 6. pp. 469-475.
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abstract = "Purpose: To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP). Methods: Within the Surveillance, Epidemiology, and End results (SEER) database (2004–2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN. Results: In 28 147 RP and PLND patients without LNI, 67.3{\%} versus 32.7{\%} exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1{\%}), GS ≥8 (25.7 vs 22.4{\%}), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1{\%}). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1{\%} for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5{\%}. Conclusion: More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals. {\circledC} 2018 Wiley Periodicals, Inc.",
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T1 - Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion

AU - Preisser, F

AU - Bandini, Marco

AU - Marchioni, Michele

AU - Nazzani, S

AU - Tian, Z

AU - Pompe, RS

AU - Fossati, Nicola

AU - Briganti, A

AU - Saad, F

AU - Shariat, SF

AU - Heinzer, H

AU - Huland, H

AU - Graefen, M

AU - Tilki, D

AU - Karakiewicz, PI

PY - 2018

Y1 - 2018

N2 - Purpose: To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP). Methods: Within the Surveillance, Epidemiology, and End results (SEER) database (2004–2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN. Results: In 28 147 RP and PLND patients without LNI, 67.3% versus 32.7% exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1%), GS ≥8 (25.7 vs 22.4%), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1%). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1% for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5%. Conclusion: More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals. © 2018 Wiley Periodicals, Inc.

AB - Purpose: To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP). Methods: Within the Surveillance, Epidemiology, and End results (SEER) database (2004–2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN. Results: In 28 147 RP and PLND patients without LNI, 67.3% versus 32.7% exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1%), GS ≥8 (25.7 vs 22.4%), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1%). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1% for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5%. Conclusion: More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals. © 2018 Wiley Periodicals, Inc.

U2 - 10.1002/pros.23491

DO - 10.1002/pros.23491

M3 - Article

VL - 78

SP - 469

EP - 475

JO - Prostate

JF - Prostate

SN - 0270-4137

IS - 6

ER -