The survival benefit of different lymph node yields in radical prostatectomy for pN1M0 prostate cancer patients: Implications from a population-based study

Abstract

Background and objectivesThe extent and survival benefits of lymph node dissection (LND) in radical prostatectomy (RP) for pN1M0 prostate cancer (PCa) patients remained unclear and were controversial. This study aimed to determine the survival benefit of different lymph node yields in RP for pN1M0 PCa patients.MethodspN1M0 PCa patients who received RP and LND were identified in Surveillance Epidemiology and End Results (SEER) (2010–2015). Patients were divided into two groups in SEER based on the removal of one to three regional lymph nodes (LND1 group) or four or more regional lymph nodes (LND4 group). Kaplan–Meier methods were used to calculate cancer-specific survival (CSS) and overall survival (OS).ResultsIn total, 2,200 patients were identified; 264 patients received LND1 and 1,936 patients received LND4. CSS had no significant difference between the LND4 and LND1 groups (101mon vs. 98mon, p = 0.064), and OS was higher in LND4 patients compared with LND1 patients (97mon vs. 93mon, p = 0.024); for patients with Gleason score = 9 or 10 and T3b or T4, 5-year OS was higher in patients undergoing LND4 (80.9%; 95% CI, 79.0–82.8) compared with those undergoing LND1 (67.5%; 95% CI, 60.8–74.2) (p = 0.009).ConclusionMore lymph node yield provided better survival for patients with Gleason score = 9 or 10 and T3b or T4, but not for other pN1M0 PCa patients. The extent of LND would be determined after a comprehensive evaluation including Gleason score, tumor stage, and the general condition of the patient.

Degenerative Changes in Aging Human Pelvic Lymph Nodes—A Reason to Rethink Staging and Therapy of Regional Malignancies?

“…In BC, lymphadenectomy prolongs time to disease recurrence and cancer-specific survival [7]. In PC, lymphadenectomy shows a significant advantage in tumor-specific survival for advanced stages of disease [5,6]. Thus, the goal of surgical tumor therapy must be the complete removal of the main tumor, as well as any regional and distant LN metastases.…”

“…Furthermore, the pathological findings contribute to the decision on adjuvant therapy [1][2][3][4]. In addition to the determination of 2 of 13 tumor extent, in prostate cancer (PC), removal of the pelvic lymph nodes (LN) reduces disease burden and has a significantly positive effect on cancer-specific survival [5,6]. In bladder cancer (BC), predictions of recurrence-free and disease-specific survival can be made based on pN stage, number of LNs involved, number of LNs removed, and LN density [7][8][9].…”

Association between pelvic lymph node dissection and survival among patients with prostate cancer treated with radical prostatectomy

“… 1 , 2 , 3 Pelvic lymph node dissection (PLND), commonly performed simultaneously during radical prostatectomy (RP), is considered the gold standard for PCa nodal staging. 4 While PLND was historically viewed as imperative due to the incidence of nodal involvement exceeding 20%, the advent of modern screening approaches including PSA has drastically diminished the proportion of patients who present with nodal metastases. 5 Moreover, contemporary imaging modalities including next-generation molecular imaging substantially improve the identification of occult nodal metastases.…”

“… 7 However, the oncologic benefits of PLND remain uncertain. 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 …”

“… 8 Similarly, it has been suggested that a more extensive PLND involving more than three regional lymph nodes primarily benefits patients with Gleason scores ≥8, whereas cancer-specific survival is unchanged in patients with lower stage PCa regardless of the number of lymph nodes removed. 4 …”