Outcomes for Patients with Clinical Lymphadenopathy Treated with Radical Prostatectomy.
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.


RESULTS
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.
Department of Urology, Mayo Clinic, Rochester, MN, USA; Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy.
Marco
M
Moschini
Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy.
Alberto
A
Briganti
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Christopher R
CR
Murphy
Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy.
Marco
M
Bianchi
Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy.
Giorgio
G
Gandaglia
Unit of Urology/Division of Oncology; IRCCS Ospedale San Raffaele; URI Milan, Italy.
Francesco
F
Montorsi
Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
J Fernando
JF
Quevedo
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Rachel
R
Carlson
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eugene
E
Kwon
Department of Urology, Mayo Clinic, Rochester, MN, USA. Electronic address: karnes.r@mayo.edu.
R Jeffrey
RJ
Karnes
D000368:Aged; 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; D010388:Pelvis; D057234:Preoperative Period; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
Lymph node metastases; Pelvic lymph node dissection; Preoperative imaging; Prostate cancer; Radical prostatectomy