Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy Journal Article
| Authors: | Touijer, K. A.; Mazzola, C. R.; Sjoberg, D. D.; Scardino, P. T.; Eastham, J. A. |
| Article 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. Design, setting, and participants We analyzed data from a consecutive cohort of 369 men with LNM treated at a single institution from 1988 to 2010. Intervention RP and extended LND. Outcome measurements and statistical analysis 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. Results and limitations 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. © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
| Keywords: | adult; cancer survival; aged; cancer surgery; major clinical study; overall survival; cancer risk; cancer adjuvant therapy; cancer patient; outcome assessment; lymph node metastasis; staging; lymph node dissection; prostate specific antigen; progression free survival; cohort analysis; retrospective study; cancer mortality; prostate cancer; gleason score; prostate; prostatectomy; cancer specific survival; long term care; radical prostatectomy; androgen deprivation therapy; biochemical recurrence; tumor invasion; seminal vesicle disease; cancer prognosis; biochemical recurrence free survival; distant metastasis free survival; metastasis free survival; prognosis; human; male; priority journal; article |
| Journal Title: | European Urology |
| Volume: | 65 |
| Issue: | 1 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2014-01-01 |
| Start Page: | 20 |
| End Page: | 25 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2013.03.053 |
| PROVIDER: | scopus |
| PUBMED: | 23619390 |
| DOI/URL: | |
| Notes: | Cited By (since 1996):2 -- Export Date: 2 January 2014 -- CODEN: EUURA -- Source: Scopus |
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