Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy Journal Article

Authors: Feifer, A. H.; Elkin, E. B.; Lowrance, W. T.; Denton, B.; Jacks, L.; Yee, D. S.; Coleman, J. A.; Laudone, V. P.; Scardino, P. T.; Eastham, J. A.
Article Title: Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy
Abstract: Background: Pelvic lymph node dissection (PLND) is an important component of prostate cancer staging and treatment, especially for surgical patients who have high-risk tumor features. It is not clear how the shift from open radical prostatectomy (ORP) to minimally invasive radical prostatectomy (MIRP) has affected the use of PLND. The objectives of this study were to identify predictors of PLND and to assess the impact of surgical technique in a contemporary, population-based cohort. Methods: In Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, the authors identified men who underwent ORP or MIRP for prostate cancer during 2003 to 2007. The impact of surgical approach on PLND was evaluated, and interactions were examined between surgical procedure, prostate-specific antigen (PSA), and Gleason score with the analysis controlled for patient and tumor characteristics. Results: Of 6608 men who underwent ORP or MIRP, 70% (n = 4600) underwent PLND. The use of PLND declined over time both overall and within subgroups defined by procedure type. PLND was 5 times more likely in men who underwent ORP than in men who underwent MIRP when the analysis was controlled for patient and tumor characteristics. Elevated PSA and biopsy Gleason score, but not clinical stage, were associated with a greater odds of PLND in both the ORP group and the MIRP group. However, the magnitude of the association between these factors and PLND was significantly greater for patients in the ORP group. Conclusions: PLND was less common among men who underwent MIRP, independent of tumor risk factors. A decline in PLND rates was not fully explained by an increase in MIRP. The authors concluded that these trends may signal a surgical approach-dependent disparity in prostate cancer staging and therapy. © 2011 American Cancer Society.
Keywords: controlled study; aged; surgical technique; major clinical study; cancer staging; lymph node dissection; lymph nodes; lymphadenectomy; prostate specific antigen; pelvis lymphadenectomy; cohort analysis; prediction; risk factor; prostate cancer; gleason score; population research; prostatectomy; intermethod comparison; minimally invasive surgery; open, robotic, and laparoscopic radical prostatectomy; surveillance, epidemiology, and end results-medicare; minimally invasive radical prostatectomy; open radical prostatectomy
Journal Title: Cancer
Volume: 117
Issue: 17
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2011-09-01
Start Page: 3933
End Page: 3942
Language: English
DOI: 10.1002/cncr.25981
PROVIDER: scopus
PMCID: PMC3136649
PUBMED: 21412757
Notes: --- - "Export Date: 3 October 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Brian Denton
    10 Denton
  2. Jonathan Coleman
    198 Coleman
  3. Vincent Laudone
    61 Laudone
  4. Peter T Scardino
    624 Scardino
  5. Elena B Elkin
    154 Elkin
  6. David Scott Yee
    19 Yee
  7. Andrew Feifer
    18 Feifer
  8. James Eastham
    437 Eastham
  9. Lindsay Jacks
    37 Jacks