Does increasing the nodal yield improve outcomes in contemporary patients without nodal metastasis undergoing radical prostatectomy?
OBJECTIVE
To determine if the number of lymph nodes (LNs) removed is an independent predictor of biochemical recurrence (BCR) in patients without LN metastases undergoing radical prostatectomy (RP).


METHODS
Retrospective analysis of 7,310 patients treated at 7 centers with RP and pelvic LN dissection for clinically localized prostate cancer between 2000 and 2011. Patients with LN metastases (n = 398) and other reasons (stated later in the article) (n = 372) were excluded, which left 6,540 patients for the final analyses.


RESULTS
Overall, median biopsy and RP Gleason score were both 7; median prostate specific antigen level was 6 ng/ml (interquartile range [IQR]: 5); and median number of LNs removed was 6 (IQR: 8). A total of 3,698 (57%), 2,064 (32%), and 508 (8%) patients had ≥ 6, ≥ 10, and ≥ 20 LNs removed, respectively. Patients with more LNs removed were older, had a higher prostate specific antigen level, had higher clinical and pathologic T stage, and had higher RP Gleason score (all P<0.002). Within a median follow-up of 21 (IQR: 16) months, more LNs removed was associated with an increased risk of BCR (continuous: P = 0.021; categorical: P = 0.014). In multivariable analyses that adjusted for the effects of standard clinicopathologic factors, none of the nodal stratifications predicted BCR.


CONCLUSIONS
The number of LNs did not have any prognostic significance in our contemporary cohort of patients with LN-negative prostate cancer. This suggests that the risk of missed clinically significant micrometastasis may be minimal in patients currently treated with RP and having a lower LN yield.
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
Luis A
LA
Kluth
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France.
Evanguelos
E
Xylinas
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Hospital of Basel, Basel, Switzerland.
Malte
M
Rieken
Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
Felix K-H
FK
Chun
Department of Urology, Landesklinikum St.Poelten, Sankt Poelten, Austria.
Harun
H
Fajkovic
Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Andreas
A
Becker
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Pierre I
PI
Karakiewicz
Department of Urology, Vita-Salute University, Milan, Italy.
Niccolo
N
Passoni
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
Michael
M
Herman
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Yair
Y
Lotan
Department of Urology, Medical University of Vienna, Vienna, Austria.
Christian
C
Seitz
Department of Urology, Medical University of Vienna, Vienna, Austria.
Paul
P
Schramek
Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
Mesut
M
Remzi
Prostate cancer center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria.
Wolfgang
W
Loidl
Department of Urology, Diaconesses Hospital, Paris 6 University, Paris, France.
Bertrand
B
Guillonneau
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médicine Pierre et Marie Curie, Paris, France.
Morgan
M
Rouprêt
Department of Urology, Vita-Salute University, Milan, Italy.
Alberto
A
Briganti
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
Douglas S
DS
Scherr
Prostate cancer center, Martini-Clinic, Hamburg, Germany.
Markus
M
Graefen
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
Ashutosh K
AK
Tewari
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
Shahrokh F
SF
Shariat
D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen
Biochemical recurrence; Lymph node metastasis; Nodal yield; Pelvic lymph node dissection; Prostate cancer