title: Differences in the rate of lymph node invasion in men with clinically localized prostate cancer might be related to the continent of origin.
abstract: OBJECTIVE
  To test whether the rate of lymph node invasion (LNI) differs between patients treated with radical prostatectomy (RP) at a European or a North American centre.
  
  
  METHODS
  In all, 1385 men had RP with bilateral lymphadenectomy for clinically localized prostate cancer (587 from Dallas, Texas and 798 from Milan, Italy). Univariate and multivariate analyses focused on the association between the continent of origin and the rate of LNI, after controlling for prostate-specific antigen (PSA) level, clinical stage, biopsy Gleason sum and the number of examined and removed lymph nodes.
  
  
  RESULTS
  European men had higher PSA levels (9.1 vs 7.8 ng/mL), a higher proportion of palpable cancers (44.5 vs 32.8%), more nodes removed (mean 14.9 vs 7.8) and a higher rate of LNI (9.0% vs 1.2%; all differences P < 0.001). In multivariate analyses that controlled for PSA level and clinical variables, European men had an 8.9-fold higher risk of LNI (P < 0.001) than their counterparts from the USA. Among preoperative variables, the continent of origin was the third most informative predictor of LNI (67.5%), after biopsy Gleason sum (74.3%) and the number of examined lymph nodes (71.0%), and improved the ability to predict LNI by 4.7%.
  
  
  CONCLUSIONS
  Men treated at a European centre had a 7.3-8.9-fold higher rate of LNI, despite adjusting for all clinical and pathological variables. It remains to be shown what predisposes European men to a higher rate of LNI.
authors.affiliation: Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Luc
authors.initials: L
authors.lastname: Valiquette
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005060:Europe / Q000208:ethnology; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000235:genetics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America / Q000208:ethnology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000235:genetics
chemical_list: D017430:Prostate-Specific Antigen