Outcomes for Patients with Clinical Lymphadenopathy Treated with Radical Prostatectomy

Marco Moschini, Alberto Briganti, Christopher R. Murphy, Marco Bianchi, Giorgio Gandaglia, Francesco Montorsi, J. Fernando Quevedo, Rachel Carlson, Eugene D Kwon, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17%) had cN+; the 252 (83%) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p = 0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p = 0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p = 0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. Patient summary: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent. Clinical node metastasis has no impact on survival in patients treated with radical prostatectomy for pathologic node-positive prostate cancer. The presence of clinical node metastasis should not be considered as an absolute contraindication to offering surgery.

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

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Prostatectomy
Neoplasm Metastasis
Lymph Nodes
Prostatic Neoplasms
Survival
Lymph Node Excision
Mortality
Lymphadenopathy
Neoplasm Grading
Neoplasms
Regression Analysis
Guidelines

Keywords

  • Lymph node metastases
  • Pelvic lymph node dissection
  • Preoperative imaging
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Outcomes for Patients with Clinical Lymphadenopathy Treated with Radical Prostatectomy. / Moschini, Marco; Briganti, Alberto; Murphy, Christopher R.; Bianchi, Marco; Gandaglia, Giorgio; Montorsi, Francesco; Quevedo, J. Fernando; Carlson, Rachel; Kwon, Eugene D; Karnes, Robert Jeffrey.

In: European Urology, 2015.

Research output: Contribution to journalArticle

Moschini, M, Briganti, A, Murphy, CR, Bianchi, M, Gandaglia, G, Montorsi, F, Quevedo, JF, Carlson, R, Kwon, ED & Karnes, RJ 2015, 'Outcomes for Patients with Clinical Lymphadenopathy Treated with Radical Prostatectomy', European Urology. https://doi.org/10.1016/j.eururo.2015.07.047
Moschini, Marco ; Briganti, Alberto ; Murphy, Christopher R. ; Bianchi, Marco ; Gandaglia, Giorgio ; Montorsi, Francesco ; Quevedo, J. Fernando ; Carlson, Rachel ; Kwon, Eugene D ; Karnes, Robert Jeffrey. / Outcomes for Patients with Clinical Lymphadenopathy Treated with Radical Prostatectomy. In: European Urology. 2015.
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abstract = "Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17{\%}) had cN+; the 252 (83{\%}) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p = 0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p = 0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p = 0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. Patient summary: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent. Clinical node metastasis has no impact on survival in patients treated with radical prostatectomy for pathologic node-positive prostate cancer. The presence of clinical node metastasis should not be considered as an absolute contraindication to offering surgery.",
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AU - Moschini, Marco

AU - Briganti, Alberto

AU - Murphy, Christopher R.

AU - Bianchi, Marco

AU - Gandaglia, Giorgio

AU - Montorsi, Francesco

AU - Quevedo, J. Fernando

AU - Carlson, Rachel

AU - Kwon, Eugene D

AU - Karnes, Robert Jeffrey

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N2 - Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17%) had cN+; the 252 (83%) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p = 0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p = 0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p = 0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. Patient summary: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent. Clinical node metastasis has no impact on survival in patients treated with radical prostatectomy for pathologic node-positive prostate cancer. The presence of clinical node metastasis should not be considered as an absolute contraindication to offering surgery.

AB - Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17%) had cN+; the 252 (83%) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p = 0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p = 0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p = 0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. Patient summary: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent. Clinical node metastasis has no impact on survival in patients treated with radical prostatectomy for pathologic node-positive prostate cancer. The presence of clinical node metastasis should not be considered as an absolute contraindication to offering surgery.

KW - Lymph node metastases

KW - Pelvic lymph node dissection

KW - Preoperative imaging

KW - Prostate cancer

KW - Radical prostatectomy

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