Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy Journal Article

   

Authors:	Von Bodman, C. ; Godoy, G.; Chade, D. C.; Cronin, A.; Tafe, L. J.; Fine, S. W.; Laudone, V.; Scardino, P. T.; Eastham, J. A.
Article Title:	Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy
Abstract:	Purpose: We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy. Materials and Methods: Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method. Results: A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes. Conclusions: Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal. © 2010 American Urological Association Education and Research, Inc.
Keywords:	adult; cancer survival; aged; disease-free survival; middle aged; major clinical study; androgen; cancer risk; cancer adjuvant therapy; cancer patient; disease free survival; recurrence risk; recurrent cancer; lymph node metastasis; lymph node dissection; pelvis lymph node; lymphatic metastasis; neoplasm staging; laparoscopy; lymph node excision; prostate specific antigen; neoplasm recurrence, local; proportional hazards models; prediction; high risk patient; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; prostate; prostatectomy; androgen antagonists; neoplasm metastasis; predictive value of tests; androgen deprivation therapy
Journal Title:	Journal of Urology
Volume:	184
Issue:	1
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2010-07-01
Start Page:	143
End Page:	148
Language:	English
DOI:	10.1016/j.juro.2010.03.039
PUBMED:	20478587
PROVIDER:	scopus
PMCID:	PMC2927114
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-77953121946&partnerID=40&md5=b109a2cadd8be3507a33994962486a01
Notes:	--- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: JOURA" - "Source: Scopus"

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