579 SIZE OF TUMOR METASTASIS AND EXTRANODAL EXTENSION STRATIFY LYMPH NODE POSITIVE PROSTATE CANCER PATIENTS INTO PROGNOSTICALLY DIFFERENT RISK GROUPS (2010)

You have accessJournal of UrologyProstate Cancer: Advanced I1 Apr 2010579 SIZE OF TUMOR METASTASIS AND EXTRANODAL EXTENSION STRATIFY LYMPH NODE POSITIVE PROSTATE CANCER PATIENTS INTO PROGNOSTICALLY DIFFERENT RISK GROUPS Daher C. Chade, Laura J. Tafe, Shahrokh F. Shariat, Guilherme Godoy, Christian von Bodman, Samson W. Fine, James A. Eastham, Peter T. Scardino, Bertrand Guillonneau, and Karim Touijer Daher C. ChadeDaher C. Chade More articles by this author , Laura J. TafeLaura J. Tafe More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Guilherme GodoyGuilherme Godoy More articles by this author , Christian von BodmanChristian von Bodman More articles by this author , Samson W. FineSamson W. Fine More articles by this author , James A. EasthamJames A. Eastham More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , Bertrand GuillonneauBertrand Guillonneau More articles by this author , and Karim TouijerKarim Touijer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.838AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The presence of nodal metastasis is a poor prognostic indicator in men with prostate cancer. However, a subset of patients with nodal metastasis remains free of disease on long-term follow-up. The aim of this study is to identify independent prognostic indicators based on a detailed pathologic slide review and clinical parameters in men with lymph node (LN) metastases. METHODS Pathologic specimens from 78 LN positive prostate cancer patients (median age: 65 years, range: 45-75) treated with radical prostatectomy and standard lymphadenectomy were retrospectively reviewed by pathologists blinded for treatment outcome. Multivariable analyses were adjusted for the effects of preoperative PSA, pathologic Gleason score, surgical margin status, extranodal extension (ENE), and seminal vesicle invasion. RESULTS The median number of nodes examined per patient was 15 (IQ: 12); the median number of positive LN was 1 (IQ: 1); the median LN density was 10% (IQ: 12%); the median metastatic tumor size was 3 mm (IQ: 4); the median maximum positive node diameter was 7 mm (IQ: 1). ENE was observed in 27 (33.8%) patients. In multivariable analyses that included only one of the LN variables to standard features per model, only metastatic tumor size and ENE were independently associated with biochemical recurrence (n=30; p=0.004 and p=0.017, respectively). Metastatic tumor size but not ENE retained its independent prognostic value when all LN features were included in the model (p=0.036 and p=0.400, respectively). In univariable analyses, metastatic tumor size and ENE were associated with metastasis to bones (n=13; p=0.001 and p=0.003, respectively). The four patients who died of prostate cancer had a significantly higher metastatic tumor size within the LN compared to those who did not (median 7, IQ: 5 vs median 2.8, IQ: 4; p=0.005). Median follow-up time for patients who did not experience disease recurrence was 30 months (IQ: 30). CONCLUSIONS The size of the tumor metastasis is powerful predictor of disease recurrence and eventual demise in patients with LN metastasis. Patients with small metastatic cancer burden in the LN and without ENE may retain a relatively favorable prognosis and may benefit from the potential therapeutic benefit of a pelvic lymphadenectomy. Such information may also play a role in the clinical decision making regarding adjuvant therapy in patients with LN metastasis after radical prostatectomy. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e227 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daher C. Chade More articles by this author Laura J. Tafe More articles by this author Shahrokh F. Shariat More articles by this author Guilherme Godoy More articles by this author Christian von Bodman More articles by this author Samson W. Fine More articles by this author James A. Eastham More articles by this author Peter T. Scardino More articles by this author Bertrand Guillonneau More articles by this author Karim Touijer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...