title: Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy.
abstract: BACKGROUND
  The presence of lymph node metastasis (LNM) at radical prostatectomy (RP) is associated with poor outcome, and optimal treatment remains undefined. An understanding of the natural history of node-positive prostate cancer (PCa) and identifying prognostic factors is needed.
  
  
  OBJECTIVE
  To assess outcomes for patients with LNM treated with RP and lymph node dissection (LND) alone.
  
  
  METHODS
  We analyzed data from a consecutive cohort of 369 men with LNM treated at a single institution from 1988 to 2010.
  
  
  METHODS
  RP and extended LND.
  
  
  METHODS
  Our primary aim was to model overall survival, PCa-specific survival, metastasis-free progression, and freedom from biochemical recurrence (BCR). We used univariate Cox proportional hazard regression models for survival outcomes. Multivariable Cox proportional hazard regression models were used for freedom from metastasis and freedom from BCR, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesical invasion, surgical margin status, and number of positive nodes as predictors.
  
  
  CONCLUSIONS
  Sixty-four patients with LNM died, 37 from disease. Seventy patients developed metastasis, and 201 experienced BCR. The predicted 10-yr overall survival and cancer-specific survival were 60% (95% confidence interval [CI], 49-69) and 72% (95% CI, 61-80), respectively. The 10-yr probability of freedom from distant metastasis and freedom from BCR were 65% (95% CI, 56-73) and 28% (95% CI, 21-36), respectively. Higher pathologic Gleason score (>7 compared with ≤ 7; hazard ratio [HR]: 2.23; 95% CI, 1.64-3.04; p < 0.0001) and three or more positive lymph nodes (HR: 2.61; 95% CI, 1.81-3.76; p < 0.0001) were significantly associated with increased risk of BCR on multivariable analysis. The retrospective nature and single-center source of data are study limitations.
  
  
  CONCLUSIONS
  A considerable subset of men with LNM remained free of disease 10 yr after RP and extended LND alone. Patients with pathologic Gleason score <8 and low nodal metastatic burden represent a favorable group. Our data confirm prior findings and support a plea for risk subclassification for patients with LNM.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA. Electronic address: touijera@mskcc.org.
authors.forename: Karim A
authors.initials: KA
authors.lastname: Touijer
authors.forename: Clarisse R
authors.initials: CR
authors.lastname: Mazzola
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sjoberg
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
mesh_terms: D000368:Aged; D000726:Androgen Antagonists; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists
keywords: Biochemical recurrence; Lymph node dissection; Lymph node metastasis; Prognosis; Prostate; Prostate cancer; Radical prostatectomy; Staging