660 PREDICTING BIOCHEMICAL RECURRENCE FREE SURVIVAL IN PATIENTS WITH POSITIVE PELVIC LYMPH NODES AT RADICAL PROSTATECTOMY (2010)

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2010660 PREDICTING BIOCHEMICAL RECURRENCE FREE SURVIVAL IN PATIENTS WITH POSITIVE PELVIC LYMPH NODES AT RADICAL PROSTATECTOMY Christian von Bodman, Guilherme Godoy, Daher C. Chade, Angel Cronin, Laura J. Tafe, Samson W. Fine, Vincent Laudone, Peter T. Scardino, and James A. Eastham Christian von BodmanChristian von Bodman More articles by this author , Guilherme GodoyGuilherme Godoy More articles by this author , Daher C. ChadeDaher C. Chade More articles by this author , Angel CroninAngel Cronin More articles by this author , Laura J. TafeLaura J. Tafe More articles by this author , Samson W. FineSamson W. Fine More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , and James A. EasthamJames A. Eastham More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1047AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated clinical and pathological predictors of freedom from biochemical recurrence (BCR) in patients with pelvic lymph node metastasis (+LN) at radical prostatectomy (RP). METHODS We identified 207 patients with LN metastasis treated with laparoscopic or open RP and bilateral pelvic lymph node dissection (BPLND) between 2000 and 2008. Patients who received any neoadjuvant therapy or adjuvant radio- or chemotherapy were excluded. 45 patients received adjuvant androgen deprivation therapy (ADT) and 162 did not. BCR was defined as prostate-specific antigen (PSA) ≥ 0.1ng/mL with one confirmatory rise. Univariate and multivariable Cox proportional hazards regression models were used to investigate predictors of BCR. Recurrence probabilities were estimated using Kaplan-Meier methods. RESULTS In the cohort of +LN patients (n=207) a median of 13 (IQR, 9-19) nodes were removed. Stratifying this cohort into patients who did not receive adjuvant ADT (n=162) and patients who received adjuvant ADT (n=45) a median of 14 (IQR, 9-20) and a median of 11 (IQR, 8-17) nodes were removed, respectively. Of the 207 patients, 59% (n=122) had only 1 +LN, 21% (n=44) had 2 and 20% (n=41) had 3 or more +LNs. In the cohort of 162 patients not receiving ADT, 64% (n=103) had one, 22% (n=35) had 2, and 15% (n=24) had 3 or more +LNs. In this subgroup 69 patients experienced BCR, with a median follow-up for BCR-free patients of 19 months. The median time to recurrence in patients with 1, 2, and 3 or more +LNs was 59, 13 and 3 months, respectively. Only specimen Gleason score (hazard ratio [HR], 2.04 for ≥ 8 vs ≤ 7; 95% CI, 1.15-3.64) and number of +LNs (HR, 1.16 for 2 vs 1 +LN; 95% CI, 0.57-2.35; HR, 3.11 for ≥ 3 vs 1 +LN; 95% CI, 1.57-6.16) were independent predictors of BCR on multivariable analysis. The recurrence free probability 2 years after RP for patients not receiving ADT with 1 +LN and a RP Gleason score ≤ 7 was 79% (95% CI, 65%-87%) versus 29% (95% CI, 14%-45%) for patients with a RP Gleason score ≥ 8 and ≥ 2 +LNs. CONCLUSIONS The prognosis of patients with LN metastasis depends on the number of positive nodes removed and the Gleason grade of the primary tumor. Despite a median of 13 (IQR 9-19) LNs removed 80% of all patients with LN metastasis had only 1 or 2 positive nodes. A surprisingly large subset of lymph node positive patients with and a RP Gleason score ≤ 7 and a single +LN have a favorable prognosis. Full BPLND should be performed in patients with intermediate and high risk cancers to optimally identify those with minimal nodal burden who may benefit the most from removal of metastatic nodes. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e258 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Christian von Bodman More articles by this author Guilherme Godoy More articles by this author Daher C. Chade More articles by this author Angel Cronin More articles by this author Laura J. Tafe More articles by this author Samson W. Fine More articles by this author Vincent Laudone More articles by this author Peter T. Scardino More articles by this author James A. Eastham More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...