Natural History of Clinical Recurrence Patterns of Lymph Node-Positive Prostate Cancer After Radical Prostatectomy

Marco Moschini, Vidit Sharma, Fabio Zattoni, J. Fernando Quevedo, Brian J. Davis, Eugene D Kwon, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature. Objective: To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes. Design, setting, and participants: Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral. Outcome measurements and statistical analysis: In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM). Results and limitations: Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31-35%) for all patients and 52.2% (95% CI, 47.3-57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n = 94, 55%), nodal (n = 59, 34%), local soft tissue (n = 29, 17%), and visceral (n = 8, 5%). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p <. 0.05). Conclusions: Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions. Patient summary: We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy. Recurrences after radical prostatectomy for lymph node-positive prostate cancer vary significantly among patients; however, patients can be stratified by demographic and pathologic characteristics to calculate prognosis and to tailor follow-up and therapeutic strategies according to type of recurrence.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - 2015

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Prostatectomy
Prostatic Neoplasms
Lymph Nodes
Recurrence
Mortality
Neoplasm Grading
Neoplasms
Confidence Intervals
Kaplan-Meier Estimate
Proportional Hazards Models

Keywords

  • Lymph node
  • Metastasis
  • Prostate cancer
  • Recurrence

ASJC Scopus subject areas

  • Urology

Cite this

Natural History of Clinical Recurrence Patterns of Lymph Node-Positive Prostate Cancer After Radical Prostatectomy. / Moschini, Marco; Sharma, Vidit; Zattoni, Fabio; Quevedo, J. Fernando; Davis, Brian J.; Kwon, Eugene D; Karnes, Robert Jeffrey.

In: European Urology, 2015.

Research output: Contribution to journalArticle

@article{32a420e28df247dc87b7cb77b450d4a0,
title = "Natural History of Clinical Recurrence Patterns of Lymph Node-Positive Prostate Cancer After Radical Prostatectomy",
abstract = "Background: Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature. Objective: To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes. Design, setting, and participants: Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral. Outcome measurements and statistical analysis: In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM). Results and limitations: Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33{\%} (95{\%} confidence interval [CI], 31-35{\%}) for all patients and 52.2{\%} (95{\%} CI, 47.3-57.1{\%}) for patients with biochemical recurrence. The solitary locations were skeletal (n = 94, 55{\%}), nodal (n = 59, 34{\%}), local soft tissue (n = 29, 17{\%}), and visceral (n = 8, 5{\%}). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80{\%}, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p <. 0.05). Conclusions: Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions. Patient summary: We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy. Recurrences after radical prostatectomy for lymph node-positive prostate cancer vary significantly among patients; however, patients can be stratified by demographic and pathologic characteristics to calculate prognosis and to tailor follow-up and therapeutic strategies according to type of recurrence.",
keywords = "Lymph node, Metastasis, Prostate cancer, Recurrence",
author = "Marco Moschini and Vidit Sharma and Fabio Zattoni and Quevedo, {J. Fernando} and Davis, {Brian J.} and Kwon, {Eugene D} and Karnes, {Robert Jeffrey}",
year = "2015",
doi = "10.1016/j.eururo.2015.03.036",
language = "English (US)",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",

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TY - JOUR

T1 - Natural History of Clinical Recurrence Patterns of Lymph Node-Positive Prostate Cancer After Radical Prostatectomy

AU - Moschini, Marco

AU - Sharma, Vidit

AU - Zattoni, Fabio

AU - Quevedo, J. Fernando

AU - Davis, Brian J.

AU - Kwon, Eugene D

AU - Karnes, Robert Jeffrey

PY - 2015

Y1 - 2015

N2 - Background: Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature. Objective: To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes. Design, setting, and participants: Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral. Outcome measurements and statistical analysis: In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM). Results and limitations: Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31-35%) for all patients and 52.2% (95% CI, 47.3-57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n = 94, 55%), nodal (n = 59, 34%), local soft tissue (n = 29, 17%), and visceral (n = 8, 5%). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p <. 0.05). Conclusions: Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions. Patient summary: We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy. Recurrences after radical prostatectomy for lymph node-positive prostate cancer vary significantly among patients; however, patients can be stratified by demographic and pathologic characteristics to calculate prognosis and to tailor follow-up and therapeutic strategies according to type of recurrence.

AB - Background: Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature. Objective: To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes. Design, setting, and participants: Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral. Outcome measurements and statistical analysis: In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM). Results and limitations: Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31-35%) for all patients and 52.2% (95% CI, 47.3-57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n = 94, 55%), nodal (n = 59, 34%), local soft tissue (n = 29, 17%), and visceral (n = 8, 5%). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p <. 0.05). Conclusions: Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions. Patient summary: We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy. Recurrences after radical prostatectomy for lymph node-positive prostate cancer vary significantly among patients; however, patients can be stratified by demographic and pathologic characteristics to calculate prognosis and to tailor follow-up and therapeutic strategies according to type of recurrence.

KW - Lymph node

KW - Metastasis

KW - Prostate cancer

KW - Recurrence

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U2 - 10.1016/j.eururo.2015.03.036

DO - 10.1016/j.eururo.2015.03.036

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JO - European Urology

JF - European Urology

SN - 0302-2838

ER -