871 MORPHOLOGIC GROWTH PATTERNS OF LYMPH NODE METASTASES PREDICT EXTENT OF TUMOR EXPANSION IN PROSTATE CANCER
2010-03-23

You have accessJournal of UrologyProstate Cancer: Advanced III1 Apr 2010871 MORPHOLOGIC GROWTH PATTERNS OF LYMPH NODE METASTASES PREDICT EXTENT OF TUMOR EXPANSION IN PROSTATE CANCER David Schilling, Joerg Hennenlotter, Ursula Kuehs, Tatjana Maul, Georgios Gakis, Karl Sotlar, and Arnulf Stenzl David SchillingDavid Schilling Tuebingen, Germany , Joerg HennenlotterJoerg Hennenlotter Tuebingen, Germany , Ursula KuehsUrsula Kuehs Tuebingen, Germany , Tatjana MaulTatjana Maul Tuebingen, Germany , Georgios GakisGeorgios Gakis Tuebingen, Germany , Karl SotlarKarl Sotlar Munich, Germany , and Arnulf StenzlArnulf Stenzl Tuebingen, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1627AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The total number of lymph node (LN) metastases is an important prognostic factor in prostate cancer. LN resection and pathologic evaluation might not depict the actual extent of tumor spread to the LN. Recently, the value of morphological pattern of metastasis distribution was identified in other malignancies like breast cancer and melanoma. Goal of this study was to define morphologic criteria to predict solitary versus multiple lymph node metastases in prostate cancer. METHODS 149 pelvic lymph nodes with prostate cancer metastases of 66 patients were stained with cytokeratine AE1/AE3. Slides were digitalized and evaluated applying predefined morphologic criteria. Area and distances were calculated using graphic software. The criteria were statistically correlated with patient groups with solitary versus multiple lymph node metastases by Wilcoxon-Kruskal-Wallis and Chi-Square-tests. In a multivariate analysis criteria which revealed significance were correlated to solitary versus multiple LN metastases as response. RESULTS In total 947 lymph nodes were resected (Median 13, range 3-45 LN per patient). 33 patients exhibited solitary metastases; 116 patients had more than one metastasis (range 2-10). The following criteria proofed significant to predict multiple metastases: Evidence of macro metastases (p=0.021), total area of the metastases (p=0.015), relative area of the metastases (p=0.002), area of the greatest focus in case of multifocal distribution (p=0.007), lymph node destruction (p=0.003), perinodal tumor growth (p=0.004), depth of tumor penetration (p=0.001) and tumor penetration depth multiplied by corresponding angle of the arc (p=0.001). 'Predominant localization of tumor cells in the area from the afferent lymph vessel to the marginal sinus' (Starz et al. 2001) and absence of 'subcapsular microanatomic localisation' (p=0.035) and absence of 'parenchymal localisation' (p=0.003) according to Dewar et al. 2004 showed significance. The latter was identified as independent factor in multivariate analysis. CONCLUSIONS To our knowledge, this is the first report about infiltration patterns of LN metastases in prostate cancer. Various morphologic criteria can predict the presence of multiple LN metastases. Large tumor volumes located at the LN margin and depth of infiltration are the strongest predictors for additional LN metastases. Report of these criteria might supplement pathologic evaluation of prostate cancer patients with LN metastases. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e340-e341 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Schilling Tuebingen, Germany More articles by this author Joerg Hennenlotter Tuebingen, Germany More articles by this author Ursula Kuehs Tuebingen, Germany More articles by this author Tatjana Maul Tuebingen, Germany More articles by this author Georgios Gakis Tuebingen, Germany More articles by this author Karl Sotlar Munich, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...