More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery

A Long-term, Multi-institutional Analysis

Nicola Fossati, William P. Parker, Robert Jeffrey Karnes, Michele Colicchia, Alberto Bossi, Thomas Seisen, Nadia Di Muzio, Cesare Cozzarini, Barbara Noris Chiorda, Claudio Fiorino, Giorgio Gandaglia, Detlef Bartkowiak, Thomas Wiegel, Shahrokh Shariat, Gregor Goldner, Antonino Battaglia, Steven Joniau, Karin Haustermans, Gert De Meerleer, Valérie Fonteyne & 5 others Piet Ost, Hein Van Poppel, Francesco Montorsi, Alberto Briganti, Stephen A. Boorjian

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Up to 50% of patients recur after salvage radiation therapy (sRT) for prostate-specific antigen (PSA) rise following radical prostatectomy (RP). Notably, the importance of lymph node dissection (LND) at the time of RP with regard to recurrence risk following sRT has not been previously determined. Therefore, we evaluated the association between nodal yield at RP and recurrence after sRT. We performed a multi-institutional review of men with a rising PSA after RP treated with sRT. Clinicopathologic variables were abstracted, and the associations between lymph node yield and biochemical (BCR) as well as clinical recurrence (CR) after sRT were assessed using multivariable Cox proportional hazards regression models. In total, 728 patients were identified; of these, 221 and 116 were diagnosed with BCR and CR, respectively, during a median follow-up of 8.4 (interquartile range: 4.2-11.2) yr. On multivariable analysis, the risk of BCR after sRT was inversely associated with the number of nodes resected at RP (hazards ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96-0.99; p = 0.049). Increased extent of dissection was also independently associated with a decreased risk of CR after sRT (HR: 0.97; 95%CI: 0.94-0.99; p = 0.042). These data support the importance of an extensive LND at surgery and may be used in prognosis assessment when sRT is being considered. Patient summary: We found that patients who had increased number of lymph nodes resected at surgery had improved outcomes after the receipt of salvage radiation therapy. These findings support the use of the extended lymph node dissection at initial surgery and should serve to improve counseling among patients who require salvage radiation therapy. The extent of pelvic lymphadenectomy at the time of radical prostatectomy is prognostic among patients who require salvage radiation therapy. These data support the inclusion of the pelvic lymphadenectomy among high-risk patients and should aid in patient counseling.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Salvage Therapy
Prostate-Specific Antigen
Prostatectomy
Lymph Node Excision
Radiotherapy
Recurrence
Counseling
Lymph Nodes
Confidence Intervals
Proportional Hazards Models
Dissection

Keywords

  • Lymph node dissection
  • Prostate cancer
  • Salvage radiation
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery : A Long-term, Multi-institutional Analysis. / Fossati, Nicola; Parker, William P.; Karnes, Robert Jeffrey; Colicchia, Michele; Bossi, Alberto; Seisen, Thomas; Di Muzio, Nadia; Cozzarini, Cesare; Chiorda, Barbara Noris; Fiorino, Claudio; Gandaglia, Giorgio; Bartkowiak, Detlef; Wiegel, Thomas; Shariat, Shahrokh; Goldner, Gregor; Battaglia, Antonino; Joniau, Steven; Haustermans, Karin; De Meerleer, Gert; Fonteyne, Valérie; Ost, Piet; Van Poppel, Hein; Montorsi, Francesco; Briganti, Alberto; Boorjian, Stephen A.

In: European Urology, 01.01.2018.

Research output: Contribution to journalArticle

Fossati, N, Parker, WP, Karnes, RJ, Colicchia, M, Bossi, A, Seisen, T, Di Muzio, N, Cozzarini, C, Chiorda, BN, Fiorino, C, Gandaglia, G, Bartkowiak, D, Wiegel, T, Shariat, S, Goldner, G, Battaglia, A, Joniau, S, Haustermans, K, De Meerleer, G, Fonteyne, V, Ost, P, Van Poppel, H, Montorsi, F, Briganti, A & Boorjian, SA 2018, 'More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery: A Long-term, Multi-institutional Analysis', European Urology. https://doi.org/10.1016/j.eururo.2018.02.024
Fossati, Nicola ; Parker, William P. ; Karnes, Robert Jeffrey ; Colicchia, Michele ; Bossi, Alberto ; Seisen, Thomas ; Di Muzio, Nadia ; Cozzarini, Cesare ; Chiorda, Barbara Noris ; Fiorino, Claudio ; Gandaglia, Giorgio ; Bartkowiak, Detlef ; Wiegel, Thomas ; Shariat, Shahrokh ; Goldner, Gregor ; Battaglia, Antonino ; Joniau, Steven ; Haustermans, Karin ; De Meerleer, Gert ; Fonteyne, Valérie ; Ost, Piet ; Van Poppel, Hein ; Montorsi, Francesco ; Briganti, Alberto ; Boorjian, Stephen A. / More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery : A Long-term, Multi-institutional Analysis. In: European Urology. 2018.
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abstract = "Up to 50{\%} of patients recur after salvage radiation therapy (sRT) for prostate-specific antigen (PSA) rise following radical prostatectomy (RP). Notably, the importance of lymph node dissection (LND) at the time of RP with regard to recurrence risk following sRT has not been previously determined. Therefore, we evaluated the association between nodal yield at RP and recurrence after sRT. We performed a multi-institutional review of men with a rising PSA after RP treated with sRT. Clinicopathologic variables were abstracted, and the associations between lymph node yield and biochemical (BCR) as well as clinical recurrence (CR) after sRT were assessed using multivariable Cox proportional hazards regression models. In total, 728 patients were identified; of these, 221 and 116 were diagnosed with BCR and CR, respectively, during a median follow-up of 8.4 (interquartile range: 4.2-11.2) yr. On multivariable analysis, the risk of BCR after sRT was inversely associated with the number of nodes resected at RP (hazards ratio [HR]: 0.98; 95{\%} confidence interval [CI]: 0.96-0.99; p = 0.049). Increased extent of dissection was also independently associated with a decreased risk of CR after sRT (HR: 0.97; 95{\%}CI: 0.94-0.99; p = 0.042). These data support the importance of an extensive LND at surgery and may be used in prognosis assessment when sRT is being considered. Patient summary: We found that patients who had increased number of lymph nodes resected at surgery had improved outcomes after the receipt of salvage radiation therapy. These findings support the use of the extended lymph node dissection at initial surgery and should serve to improve counseling among patients who require salvage radiation therapy. The extent of pelvic lymphadenectomy at the time of radical prostatectomy is prognostic among patients who require salvage radiation therapy. These data support the inclusion of the pelvic lymphadenectomy among high-risk patients and should aid in patient counseling.",
keywords = "Lymph node dissection, Prostate cancer, Salvage radiation, Survival",
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T1 - More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery

T2 - A Long-term, Multi-institutional Analysis

AU - Fossati, Nicola

AU - Parker, William P.

AU - Karnes, Robert Jeffrey

AU - Colicchia, Michele

AU - Bossi, Alberto

AU - Seisen, Thomas

AU - Di Muzio, Nadia

AU - Cozzarini, Cesare

AU - Chiorda, Barbara Noris

AU - Fiorino, Claudio

AU - Gandaglia, Giorgio

AU - Bartkowiak, Detlef

AU - Wiegel, Thomas

AU - Shariat, Shahrokh

AU - Goldner, Gregor

AU - Battaglia, Antonino

AU - Joniau, Steven

AU - Haustermans, Karin

AU - De Meerleer, Gert

AU - Fonteyne, Valérie

AU - Ost, Piet

AU - Van Poppel, Hein

AU - Montorsi, Francesco

AU - Briganti, Alberto

AU - Boorjian, Stephen A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Up to 50% of patients recur after salvage radiation therapy (sRT) for prostate-specific antigen (PSA) rise following radical prostatectomy (RP). Notably, the importance of lymph node dissection (LND) at the time of RP with regard to recurrence risk following sRT has not been previously determined. Therefore, we evaluated the association between nodal yield at RP and recurrence after sRT. We performed a multi-institutional review of men with a rising PSA after RP treated with sRT. Clinicopathologic variables were abstracted, and the associations between lymph node yield and biochemical (BCR) as well as clinical recurrence (CR) after sRT were assessed using multivariable Cox proportional hazards regression models. In total, 728 patients were identified; of these, 221 and 116 were diagnosed with BCR and CR, respectively, during a median follow-up of 8.4 (interquartile range: 4.2-11.2) yr. On multivariable analysis, the risk of BCR after sRT was inversely associated with the number of nodes resected at RP (hazards ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96-0.99; p = 0.049). Increased extent of dissection was also independently associated with a decreased risk of CR after sRT (HR: 0.97; 95%CI: 0.94-0.99; p = 0.042). These data support the importance of an extensive LND at surgery and may be used in prognosis assessment when sRT is being considered. Patient summary: We found that patients who had increased number of lymph nodes resected at surgery had improved outcomes after the receipt of salvage radiation therapy. These findings support the use of the extended lymph node dissection at initial surgery and should serve to improve counseling among patients who require salvage radiation therapy. The extent of pelvic lymphadenectomy at the time of radical prostatectomy is prognostic among patients who require salvage radiation therapy. These data support the inclusion of the pelvic lymphadenectomy among high-risk patients and should aid in patient counseling.

AB - Up to 50% of patients recur after salvage radiation therapy (sRT) for prostate-specific antigen (PSA) rise following radical prostatectomy (RP). Notably, the importance of lymph node dissection (LND) at the time of RP with regard to recurrence risk following sRT has not been previously determined. Therefore, we evaluated the association between nodal yield at RP and recurrence after sRT. We performed a multi-institutional review of men with a rising PSA after RP treated with sRT. Clinicopathologic variables were abstracted, and the associations between lymph node yield and biochemical (BCR) as well as clinical recurrence (CR) after sRT were assessed using multivariable Cox proportional hazards regression models. In total, 728 patients were identified; of these, 221 and 116 were diagnosed with BCR and CR, respectively, during a median follow-up of 8.4 (interquartile range: 4.2-11.2) yr. On multivariable analysis, the risk of BCR after sRT was inversely associated with the number of nodes resected at RP (hazards ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96-0.99; p = 0.049). Increased extent of dissection was also independently associated with a decreased risk of CR after sRT (HR: 0.97; 95%CI: 0.94-0.99; p = 0.042). These data support the importance of an extensive LND at surgery and may be used in prognosis assessment when sRT is being considered. Patient summary: We found that patients who had increased number of lymph nodes resected at surgery had improved outcomes after the receipt of salvage radiation therapy. These findings support the use of the extended lymph node dissection at initial surgery and should serve to improve counseling among patients who require salvage radiation therapy. The extent of pelvic lymphadenectomy at the time of radical prostatectomy is prognostic among patients who require salvage radiation therapy. These data support the inclusion of the pelvic lymphadenectomy among high-risk patients and should aid in patient counseling.

KW - Lymph node dissection

KW - Prostate cancer

KW - Salvage radiation

KW - Survival

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