Extended pelvic lymphadenectomy in patients with clinically localized prostate cancer: A prospective observational study

Ramos, José Gustavo; Caicedo, Juan Ignacio; Cataño, Juan Guillermo; Villarraga, Luis Gabriel; Trujillo, Carlos Gustavo; Robledo, Daniela; Plata, Mauricio

doi:10.1016/j.acuroe.2016.06.006

Cited by 3 publications

(5 citation statements)

References 24 publications

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Section: Discussionmentioning

confidence: 99%

“…9 Due to studies like these, ePLND is performed in all low-risk patients at this specific institution. Additionally, it can significantly increase disease-free survival in patients with a low lymph node metastasis burden and increase a significant benefit of bRFS 5,10 Although not performing PLND in these patients is a globally accepted behavior, it should be taken into account that more than half of the patients are under-classified. In this series, all patients started with GG1, but the pathology showed that more than half of these patients upstage GG, which changes the classification for the majority of them to intermediate risk.…”

Section: Discussionmentioning

confidence: 99%

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Biochemical Relapse in Low-risk Prostate Cancer Treated with Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy

Bellini

Ramos

Becerra

et al. 2022

Revista Urología Colombiana / Colombian Urology Journal

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Introduction For low-risk prostate cancer (PCa), curative treatment with radical prostatectomy (RP) can be performed, reporting a biochemical relapse-free survival rate (bRFS) at 5 and 7 years of 90.1% and 88.3%, respectively. Prostatic specific antigen (PSA), pathological stage (pT), and positive margins (R1) are significant predictors of biochemical relapse (BR). Even though pelvic lymphadenectomy is not recommended during RP, in the literature, it is performed in 34% of these patients, finding 0.37% of positive lymph nodes (N1). In this study, we aim to evaluate the 10-year bRFS in patients with low-risk PCa who underwent RP and extended pelvic lymph node dissection (ePLND). Methodology All low-risk patients who underwent RP plus bilateral ePLND at the National Cancer Institute of Colombia between 2006 and 2019 were reviewed. Biochemical relapse was defined as 2 consecutive increasing levels of PSA > 0.2 ng/mL. A descriptive analysis was performed using the STATA 15 software (Stata Corp., College Station, TX, USA), and the Kaplan-Meier curves and uni and multivariate Cox proportional hazard models were used for the survival outcome analysis. The related regression coefficients were used for the hazard ratio (HR), and, for all comparisons, a two-sided p-value ˂ 0.05 was used to define statistical significance. Results Two hundred and two patients met the study criteria. The 10-year bRFS for the general population was 82.5%, statistically related to stage pT3 (p = 0.047), higher Gleason grade group (GG) (p ≤ 0.001), and R1 (p ≤ 0.001), but not with N1. A total of 3.9% of the patients had N1; of these, 75% had R1, 25% GG2, and 37% GG3. Among the N0 (non-lymph node metástasis in prostate cáncer) patients, 31% of the patients had R1, 41% GG2, and 13% GG3. Conclusions Our bRFS was 82.5% in low-risk patients who underwent RP and ePLND. With higher pT, GG, and presence of R1, the probability of BR increased. Those with pN1 (pathologicaly confirmed positive lymph nodes) were not associated with bRFS, with a pN1 detection rate of 3.9%. Details: In low-risk PCa, curative treatment with RP can be performed, reporting a bRFS rate at 5 and 7 years of 90.1% and 88.3%, respectively. Despite the fact that pelvic lymphadenectomy is not recommended during RP in clinical guidelines, in the literature, it is performed in 34% of these patients, finding 0.37% of N1. In this study, we report the 10-year bRFS in patients with low-risk PCa who underwent surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biochemical Relapse in Low-risk Prostate Cancer Treated with Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy

Bellini

Ramos

Becerra

et al. 2022

Revista Urología Colombiana / Colombian Urology Journal

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“…1. Pelvic lymph nodes: I -obturator; II -external iliac; III -internal iliac; IV -common iliac; V -presacral (reproduced from [7] with permission of the authors) Отмеченные разновидности ТЛАЭ имеют неодина ковую диагностическую ценность: весьма низкую для ограниченного и стандартного вариантов (в таких случаях возможна недооценка числа пораженных тазо вых ЛУ примерно у 50 % пациентов) [8,9] и существен но более высокую при применении РТЛАЭ [9][10][11][12].…”

Section: рис 1 тазовые лимфатические узлы: I -запирательные; Ii -нару...unclassified

“…Significance of differences (log-rank test, Mantel-Cox test) between: Groups 1 and 2 -р <0.001; Groups 1 and 3 -р = 0.327; between Groups 2 and 3 -р <0.001. 11 (9,8) 39 (11,6) 18 (4,9) Число выживших пациентов (цензурированные данные), n (%)…”

Section: показательunclassified

Pelvic lymphadenectomy for radical prostatectomy: perioperative and oncological results

Popov¹,

Guseynov

Орлов

et al. 2022

Onkourologiâ

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Background. Currently, in men suffering from prostate cancer, histological examination of the material obtained during pelvic lymphadenectomy (PLAE) is the most accurate and reliable method for staging the tumor process and postoperative prognosis of disease outcomes, an important factor influencing the choice of the most rational treatment tactics after radical prostatectomy. However, today questions about the therapeutic (oncological) expediency of PLAE and its safety in terms of the development of intra- and postoperative complications remain debatable.Aim. To was to compare the perioperative and therapeutic (oncological) results of radical prostat ectomy performed in combination with standard or extended PLAE.Materials and methods. The study materials were the data of medical records of 812 men aged 43 to 78 years, at different times (from January 2009 to December 2018) who were hospitalized for localized or locally advanced prostate cancer in stages cT1a–cT3bN0M0. The research method was a retrospective analysis of the data contained in the selected medical records.Results and conclusion. The results of our studies, firstly, confirm the conclusions of the European Association of Urology (EAU) experts on the justification and necessity of performing an extended PLAE with radical prostatectomy in order to diagnose metastatic lesions of the pelvic lymph nodes in individuals with an intermediate or high risk of prostate cancer progression; secondly, they indicate a higher therapeutic efficacy of extended PLAE compared to that for standard PLAE, which is expressed in a statistically significantly three times lower incidence of biochemical relapses and an 11.4 % longer relapse-free period after extended PLAE than after standard PLAE. Extended PLAE, performed in one surgical session with radical prostatectomy, is not a risk factor for the development of various intra- and postoperative complications, with the exception of the lymphocele, which is formed in 3.7–13.5 % of cases of extended PLAE due to intraoperative transection of lymphatic vessels and lymph accumulation at the site of the removed adipose tissue.

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“…The ePLND template applied included harvesting nodes overlying the obturator fossa; the external iliac vessels, the internal iliac artery and the common iliac vessels and the presacral stations may be removed, which would allow for clearing 75% of all anatomical landing sites of LN metastases. 28,29 All the LNs harvested were centrally reviewed by a uropathologist at our institution.…”

Section: Introductionmentioning

confidence: 99%

Predicting the Probability of Lymph Node Involvement with Prostate Cancer Nomograms: Can We Trust the Prediction Models?

Soto

Barco‐Castillo

Santander

et al. 2020

Revista Urología Colombiana / Colombian Urology Journal

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Introduction Prediction of lymph node involvement (LNI) is of paramount importance for patients with prostate cancer (PCa) undergoing radical prostatectomy (RP). Multiple statistical models predicting LNI have been developed to support clinical decision-making regarding the need of extended pelvic lymph node dissection (ePLND). Our aim is to evaluate the prediction ability of the best-performing prediction tools for LNI in PCa in a Latin-American population. Methods Clinicopathological data of 830 patients with PCa who underwent RP and ePLND between 2007 and 2018 was obtained. Only data from patients who had ≥ 10 lymph nodes (LNs) harvested were included (n = 576 patients). Four prediction models were validated using this cohort: The Memorial Sloan Kettering Cancer Center (MSKCC) web calculator, Briganti v.2017, Yale formula and Partin tables v.2016. The performance of the prediction tools was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results The median age was 61 years old (interquartile range [IQR] 56–66), the median Prostate specific antigen (PSA) was 6,81 ng/mL (IQR 4,8–10,1) and the median of LNs harvested was 17 (IQR 13–23), and LNI was identified in 53 patients (9.3%). Predictions from the 2017 Briganti nomogram AUC (0.85) and the Yale formula AUC (0.85) were the most accurate; MSKCC and 2016 Partin tables AUC were both 0,84. Conclusion There was no significant difference in the performance of the four validated prediction tools in a Latin-American population compared with the European or North American patients in whom these tools have been validated. Among the 4 models, the Briganti v.2017 and Yale formula yielded the best results, but the AUC overlapped with the other validated models.

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Extended pelvic lymphadenectomy in patients with clinically localized prostate cancer: A prospective observational study

Cited by 3 publications

References 24 publications

Biochemical Relapse in Low-risk Prostate Cancer Treated with Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy

Biochemical Relapse in Low-risk Prostate Cancer Treated with Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy

Pelvic lymphadenectomy for radical prostatectomy: perioperative and oncological results

Predicting the Probability of Lymph Node Involvement with Prostate Cancer Nomograms: Can We Trust the Prediction Models?

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