Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer

G Gandaglia, E Zaffuto, Nicola Fossati, Marco Bandini, N Suardi, Elio Mazzone, P Dell'Oglio, Armando Stabile, M Freschi, F Montorsi, A Briganti

Research output: Contribution to journalArticle

Abstract

Objectives: To assess if the preoperative lymph node invasion (LNI) risk could be used to tailor the extent of pelvic lymph node dissection (PLND) according to individual profile in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), and to identify those who would benefit from the removal of the common iliac and pre-sacral nodes. Patients and Methods: A total of 471 patients with high-risk PCa treated with RP and a super-extended PLND that included the removal of the pre-sacral and common iliac nodes between 2006 and 2016 were identified. The risk of LNI was calculated according to the Briganti nomogram. Multivariable logistic regression analyses assessed the association between LNI risk and involvement of the common iliac and pre-sacral regions. The risk of positive common iliac and pre-sacral nodes was plotted over the LNI risk using the LOWESS-smoothed fit curve. Results: The median preoperative LNI risk was 25.5%. The median number of nodes removed was 23, and 171 (36.3%) patients had LNI. Overall, 61 (13.0%) and 28 patients (5.9%), respectively, had positive common iliac and pre-sacral nodes alone or in combination with other sites. The LNI risk was associated with the involvement of the common iliac and pre-sacral regions (all P < 0.001). The proportion of patients with positive common iliac and pre-sacral nodes progressively increased according to the LNI risk. The adoption of a 30% threshold would result in avoiding the removal of the common iliac and pre-sacral nodes in > 60% cases, with a risk of missing LNI in these regions of <5%. Conclusions: Fewer than 5% of patients with an LNI risk of <30% harbour positive common iliac and pre-sacral nodes. A super-extended PLND that includes the dissection of these regions should be considered exclusively in patients with an LNI risk ≥30%. © 2017 BJU International.
Original languageEnglish
Pages (from-to)421-427
Number of pages7
JournalBJU International
Volume121
Issue number3
DOIs
Publication statusPublished - 2018

Fingerprint

Lymph Node Excision
Prostatic Neoplasms
Lymph Nodes
Sacrococcygeal Region
Prostatectomy
Nomograms
Dissection
Logistic Models
Regression Analysis

Cite this

Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer. / Gandaglia, G; Zaffuto, E; Fossati, Nicola; Bandini, Marco; Suardi, N; Mazzone, Elio; Dell'Oglio, P; Stabile, Armando; Freschi, M; Montorsi, F; Briganti, A.

In: BJU International, Vol. 121, No. 3, 2018, p. 421-427.

Research output: Contribution to journalArticle

Gandaglia, G, Zaffuto, E, Fossati, N, Bandini, M, Suardi, N, Mazzone, E, Dell'Oglio, P, Stabile, A, Freschi, M, Montorsi, F & Briganti, A 2018, 'Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer', BJU International, vol. 121, no. 3, pp. 421-427. https://doi.org/10.1111/bju.14066
Gandaglia, G ; Zaffuto, E ; Fossati, Nicola ; Bandini, Marco ; Suardi, N ; Mazzone, Elio ; Dell'Oglio, P ; Stabile, Armando ; Freschi, M ; Montorsi, F ; Briganti, A. / Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer. In: BJU International. 2018 ; Vol. 121, No. 3. pp. 421-427.
@article{b851d7a89313499cb8f796ac612dfb27,
title = "Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer",
abstract = "Objectives: To assess if the preoperative lymph node invasion (LNI) risk could be used to tailor the extent of pelvic lymph node dissection (PLND) according to individual profile in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), and to identify those who would benefit from the removal of the common iliac and pre-sacral nodes. Patients and Methods: A total of 471 patients with high-risk PCa treated with RP and a super-extended PLND that included the removal of the pre-sacral and common iliac nodes between 2006 and 2016 were identified. The risk of LNI was calculated according to the Briganti nomogram. Multivariable logistic regression analyses assessed the association between LNI risk and involvement of the common iliac and pre-sacral regions. The risk of positive common iliac and pre-sacral nodes was plotted over the LNI risk using the LOWESS-smoothed fit curve. Results: The median preoperative LNI risk was 25.5{\%}. The median number of nodes removed was 23, and 171 (36.3{\%}) patients had LNI. Overall, 61 (13.0{\%}) and 28 patients (5.9{\%}), respectively, had positive common iliac and pre-sacral nodes alone or in combination with other sites. The LNI risk was associated with the involvement of the common iliac and pre-sacral regions (all P < 0.001). The proportion of patients with positive common iliac and pre-sacral nodes progressively increased according to the LNI risk. The adoption of a 30{\%} threshold would result in avoiding the removal of the common iliac and pre-sacral nodes in > 60{\%} cases, with a risk of missing LNI in these regions of <5{\%}. Conclusions: Fewer than 5{\%} of patients with an LNI risk of <30{\%} harbour positive common iliac and pre-sacral nodes. A super-extended PLND that includes the dissection of these regions should be considered exclusively in patients with an LNI risk ≥30{\%}. {\circledC} 2017 BJU International.",
author = "G Gandaglia and E Zaffuto and Nicola Fossati and Marco Bandini and N Suardi and Elio Mazzone and P Dell'Oglio and Armando Stabile and M Freschi and F Montorsi and A Briganti",
year = "2018",
doi = "10.1111/bju.14066",
language = "English",
volume = "121",
pages = "421--427",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "3",

}

TY - JOUR

T1 - Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer

AU - Gandaglia, G

AU - Zaffuto, E

AU - Fossati, Nicola

AU - Bandini, Marco

AU - Suardi, N

AU - Mazzone, Elio

AU - Dell'Oglio, P

AU - Stabile, Armando

AU - Freschi, M

AU - Montorsi, F

AU - Briganti, A

PY - 2018

Y1 - 2018

N2 - Objectives: To assess if the preoperative lymph node invasion (LNI) risk could be used to tailor the extent of pelvic lymph node dissection (PLND) according to individual profile in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), and to identify those who would benefit from the removal of the common iliac and pre-sacral nodes. Patients and Methods: A total of 471 patients with high-risk PCa treated with RP and a super-extended PLND that included the removal of the pre-sacral and common iliac nodes between 2006 and 2016 were identified. The risk of LNI was calculated according to the Briganti nomogram. Multivariable logistic regression analyses assessed the association between LNI risk and involvement of the common iliac and pre-sacral regions. The risk of positive common iliac and pre-sacral nodes was plotted over the LNI risk using the LOWESS-smoothed fit curve. Results: The median preoperative LNI risk was 25.5%. The median number of nodes removed was 23, and 171 (36.3%) patients had LNI. Overall, 61 (13.0%) and 28 patients (5.9%), respectively, had positive common iliac and pre-sacral nodes alone or in combination with other sites. The LNI risk was associated with the involvement of the common iliac and pre-sacral regions (all P < 0.001). The proportion of patients with positive common iliac and pre-sacral nodes progressively increased according to the LNI risk. The adoption of a 30% threshold would result in avoiding the removal of the common iliac and pre-sacral nodes in > 60% cases, with a risk of missing LNI in these regions of <5%. Conclusions: Fewer than 5% of patients with an LNI risk of <30% harbour positive common iliac and pre-sacral nodes. A super-extended PLND that includes the dissection of these regions should be considered exclusively in patients with an LNI risk ≥30%. © 2017 BJU International.

AB - Objectives: To assess if the preoperative lymph node invasion (LNI) risk could be used to tailor the extent of pelvic lymph node dissection (PLND) according to individual profile in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), and to identify those who would benefit from the removal of the common iliac and pre-sacral nodes. Patients and Methods: A total of 471 patients with high-risk PCa treated with RP and a super-extended PLND that included the removal of the pre-sacral and common iliac nodes between 2006 and 2016 were identified. The risk of LNI was calculated according to the Briganti nomogram. Multivariable logistic regression analyses assessed the association between LNI risk and involvement of the common iliac and pre-sacral regions. The risk of positive common iliac and pre-sacral nodes was plotted over the LNI risk using the LOWESS-smoothed fit curve. Results: The median preoperative LNI risk was 25.5%. The median number of nodes removed was 23, and 171 (36.3%) patients had LNI. Overall, 61 (13.0%) and 28 patients (5.9%), respectively, had positive common iliac and pre-sacral nodes alone or in combination with other sites. The LNI risk was associated with the involvement of the common iliac and pre-sacral regions (all P < 0.001). The proportion of patients with positive common iliac and pre-sacral nodes progressively increased according to the LNI risk. The adoption of a 30% threshold would result in avoiding the removal of the common iliac and pre-sacral nodes in > 60% cases, with a risk of missing LNI in these regions of <5%. Conclusions: Fewer than 5% of patients with an LNI risk of <30% harbour positive common iliac and pre-sacral nodes. A super-extended PLND that includes the dissection of these regions should be considered exclusively in patients with an LNI risk ≥30%. © 2017 BJU International.

U2 - 10.1111/bju.14066

DO - 10.1111/bju.14066

M3 - Article

VL - 121

SP - 421

EP - 427

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 3

ER -