Risk Stratification of pN+ Prostate Cancer after Radical Prostatectomy from a Large Single Institutional Series with Long-Term Followup

Marco Moschini, Vidit Sharma, Fabio Zattoni, Stephen A. Boorjian, Igor Frank, Matthew T. Gettman, R. Houston Thompson, Matthew K. Tollefson, Eugene D Kwon, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Purpose Lymph node positive (pN+) prostate cancer after radical prostatectomy has wide variability in long-Term oncologic outcomes. We present a large institutional series with extended followup to create an oncologic risk stratification system that clarifies the prognostic heterogeneity for patients with pN+ disease after radical prostatectomy. Materials and Methods Men with pN+ prostate cancer after radical prostatectomy during 1987 to 2012 were included in the study. Regression models were created to identify significant predictors of biochemical recurrence, metastasis, cancer specific mortality and overall mortality. A cancer specific mortality risk score was then created and internally validated to stratify patients in terms of risk of cancer specific mortality. Results For our cohort of 1,011 men with a median followup of 17.6 years the 20-year rate of cancer specific mortality was 31%. On multivariate Cox regression modeling 3 or more positive nodes (HR 1.75, p=0.003), pathological Gleason score 7 vs 6 (HR 1.74, p=0.04) and 8-10 vs 6 (HR 2.63, p=0.001), and positive surgical margins (HR 1.96, p=0.001) were significantly associated with increased cancer specific mortality, while adjuvant radiotherapy (HR 0.40, p=0.008) was associated with decreased cancer specific mortality. A cancer specific mortality risk score was then created using these 4 variables to stratify patients with markedly different prognoses, yielding 20-year cancer specific mortality rates of 19.1% vs 34% vs 46% (p

Original languageEnglish (US)
Pages (from-to)1773-1778
Number of pages6
JournalJournal of Urology
Volume195
Issue number6
DOIs
StatePublished - Jun 1 2016

Keywords

  • lymph nodes
  • prostatectomy
  • prostatic neoplasms
  • survival

ASJC Scopus subject areas

  • Urology

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    Moschini, M., Sharma, V., Zattoni, F., Boorjian, S. A., Frank, I., Gettman, M. T., Houston Thompson, R., Tollefson, M. K., Kwon, E. D., & Karnes, R. J. (2016). Risk Stratification of pN+ Prostate Cancer after Radical Prostatectomy from a Large Single Institutional Series with Long-Term Followup. Journal of Urology, 195(6), 1773-1778. https://doi.org/10.1016/j.juro.2015.12.074