title: Number of metastatic lymph nodes as determinant of outcome after salvage radical prostatectomy for radiation-recurrent prostate cancer.
abstract: BACKGROUND
  Presence of lymph node metástasis (LNM) at salvage radical prostatectomy (sRP) is associated with poor outcome. Predictors of outcome in this context remain undetermined. ThE objective was to assess the role of number of positive lymph node on outcome of patients with LNM after sRP and for radio-recurrent prostate cancer.
  
  
  METHODS
  We analyzed data from a consecutive cohort of 215 men treated with sRP at a single institution. We used univariate Cox proportional hazard regression models for biochemical recurrence (BCR) and metastatic outcomes, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesicle invasion, time between radiation therapy and sRP, and number of positive nodes as predictors.
  
  
  RESULTS
  Of the 47 patients with LNM, 37 developed BCR, 11 developed distant metastasis and 4 died with a median follow-up of 2.3 years for survivors. The risk of metastases increased with higher pre-operative PSA levels (HR 1.19 per 1ng/ml; 95% CI: 1.06-1.34; P=.003). The remaining predictors did not reach conventional levels of significance. However, removal of 3 or more positive lymph nodes demonstrated a positive association, as expected, with metastatic disease (HR 3.44; 95% CI: 0.91-13.05; P=.069) compared to one or 2 positive nodes. Similarly, the presence of extraprostatic extension, seminal vesicle invasion and Gleason grade greater than 7 also demonstrated a positive association with higher risk of metástasis, with hazard ratios of 3.97 (95% CI: 0.50, 31.4; P=.2), 3.72 (95% CI: 0.80-17.26; P=.1), and 1.45 (95% CI: 0.44-4.76; P=.5), respectively.
  
  
  CONCLUSIONS
  In patients with LNM after sRP for radio-recurrent prostate cancer, the risk of distant metástasis is likely to be influenced by the number of positive nodes (3 or more), high preoperative PSA, Gleason grade and advanced pathologic stage. These results are consistent with the findings of number of nodes (1 to 2 vs. 3 or more nodes positive) as a prognostic indicator after primary radical prostatectomy and strengthen the plea for a revision of the nodal staging for prostate cancer.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.
authors.forename: G
authors.initials: G
authors.lastname: Gugliemetti
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.
authors.forename: R
authors.initials: R
authors.lastname: Sukhu
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.
authors.forename: M A
authors.initials: MA
authors.lastname: Conca Baenas
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.
authors.forename: J
authors.initials: J
authors.lastname: Meeks
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.
authors.forename: D D
authors.initials: DD
authors.lastname: Sjoberg
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.; Department of Urology, Weill Medical College of Cornell University, Nueva York, NY, EE. UU.
authors.forename: J A
authors.initials: JA
authors.lastname: Eastham
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.; Department of Urology, Weill Medical College of Cornell University, Nueva York, NY, EE. UU.
authors.forename: P T
authors.initials: PT
authors.lastname: Scardino
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Nueva York, NY, EE. UU.; Department of Urology, Weill Medical College of Cornell University, Nueva York, NY, EE. UU.. Electronic address: touijera@mskcc.org.
authors.forename: K
authors.initials: K
authors.lastname: Touijer
mesh_terms: D000368:Aged; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Cáncer de próstata; Disección de ganglios linfáticos; Estadificación; Lymph node dissection; Lymph node metástasis; Metástasis de ganglios linfáticos; Prognosis; Pronóstico; Prostate cancer; Radiation therapy; Radioterapia; Salvage therapy; Staging; Terapia de rescate