Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy

Felix Preisser; Reha Baris Incesu; Pawel Rajwa; Marcin Chlosta; Mohamed Ahmed; Andre Luis Abreu; Giovanni Cacciamani; Luis Ribeiro; Alexander Kretschmer; Thilo Westhofen; Joseph A. Smith; Markus Graefen; Giorgio Calleris; Yannic Raskin; Paolo Gontero; Steven Joniau; Rafael Sanchez-Salas; Shahrokh F. Shariat; Inderbir Gill; Robert Jeffrey Karnes; Paul Cathcart; Henk Van Der Poel; Giancarlo Marra; Derya Tilki

doi:10.3390/cancers15123123

Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy

Felix Preisser, Reha Baris Incesu, Pawel Rajwa, Marcin Chlosta, Mohamed Ahmed, Andre Luis Abreu, Giovanni Cacciamani, Luis Ribeiro, Alexander Kretschmer, Thilo Westhofen, Joseph A. Smith, Markus Graefen, Giorgio Calleris, Yannic Raskin, Paolo Gontero, Steven Joniau, Rafael Sanchez-Salas, Shahrokh F. Shariat, Inderbir Gill, Robert Jeffrey KarnesPaul Cathcart, Henk Van Der Poel, Giancarlo Marra, Derya Tilki

Urology

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. Patients and methods: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan–Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). Results: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p < 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p < 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p < 0.001) and death (HR: 2.89, p < 0.001). Conclusions: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI.

Original language	English (US)
Article number	3123
Journal	Cancers
Volume	15
Issue number	12
DOIs	https://doi.org/10.3390/cancers15123123
State	Published - Jun 2023

Keywords

BCR
lymph node dissection
lymph node invasion
oncological outcomes
salvage prostatectomy

ASJC Scopus subject areas

Oncology
Cancer Research

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10.3390/cancers15123123

Cite this

Preisser, F., Incesu, R. B., Rajwa, P., Chlosta, M., Ahmed, M., Abreu, A. L., Cacciamani, G., Ribeiro, L., Kretschmer, A., Westhofen, T., Smith, J. A., Graefen, M., Calleris, G., Raskin, Y., Gontero, P., Joniau, S., Sanchez-Salas, R., Shariat, S. F., Gill, I., ... Tilki, D. (2023). Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy. Cancers, 15(12), Article 3123. https://doi.org/10.3390/cancers15123123

Preisser, F, Incesu, RB, Rajwa, P, Chlosta, M, Ahmed, M, Abreu, AL, Cacciamani, G, Ribeiro, L, Kretschmer, A, Westhofen, T, Smith, JA, Graefen, M, Calleris, G, Raskin, Y, Gontero, P, Joniau, S, Sanchez-Salas, R, Shariat, SF, Gill, I, Karnes, RJ, Cathcart, P, Van Der Poel, H, Marra, G & Tilki, D 2023, 'Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy', Cancers, vol. 15, no. 12, 3123. https://doi.org/10.3390/cancers15123123

@article{5b67817dbbb0431ea30bac3c7ffb399f,

title = "Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy",

abstract = "Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. Patients and methods: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan–Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). Results: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p < 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p < 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p < 0.001) and death (HR: 2.89, p < 0.001). Conclusions: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI.",

keywords = "BCR, lymph node dissection, lymph node invasion, oncological outcomes, salvage prostatectomy",

author = "Felix Preisser and Incesu, {Reha Baris} and Pawel Rajwa and Marcin Chlosta and Mohamed Ahmed and Abreu, {Andre Luis} and Giovanni Cacciamani and Luis Ribeiro and Alexander Kretschmer and Thilo Westhofen and Smith, {Joseph A.} and Markus Graefen and Giorgio Calleris and Yannic Raskin and Paolo Gontero and Steven Joniau and Rafael Sanchez-Salas and Shariat, {Shahrokh F.} and Inderbir Gill and Karnes, {Robert Jeffrey} and Paul Cathcart and {Van Der Poel}, Henk and Giancarlo Marra and Derya Tilki",

note = "Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = jun,

doi = "10.3390/cancers15123123",

language = "English (US)",

volume = "15",

journal = "Cancers",

issn = "2072-6694",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "12",

}

TY - JOUR

T1 - Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy

AU - Preisser, Felix

AU - Incesu, Reha Baris

AU - Rajwa, Pawel

AU - Chlosta, Marcin

AU - Ahmed, Mohamed

AU - Abreu, Andre Luis

AU - Cacciamani, Giovanni

AU - Ribeiro, Luis

AU - Kretschmer, Alexander

AU - Westhofen, Thilo

AU - Smith, Joseph A.

AU - Graefen, Markus

AU - Calleris, Giorgio

AU - Raskin, Yannic

AU - Gontero, Paolo

AU - Joniau, Steven

AU - Sanchez-Salas, Rafael

AU - Shariat, Shahrokh F.

AU - Gill, Inderbir

AU - Karnes, Robert Jeffrey

AU - Cathcart, Paul

AU - Van Der Poel, Henk

AU - Marra, Giancarlo

AU - Tilki, Derya

PY - 2023/6

Y1 - 2023/6

N2 - Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. Patients and methods: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan–Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). Results: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p < 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p < 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p < 0.001) and death (HR: 2.89, p < 0.001). Conclusions: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI.

AB - Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. Patients and methods: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan–Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). Results: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p < 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p < 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p < 0.001) and death (HR: 2.89, p < 0.001). Conclusions: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI.

KW - BCR

KW - lymph node dissection

KW - lymph node invasion

KW - oncological outcomes

KW - salvage prostatectomy

UR - http://www.scopus.com/inward/record.url?scp=85163795686&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85163795686&partnerID=8YFLogxK

U2 - 10.3390/cancers15123123

DO - 10.3390/cancers15123123

M3 - Article

AN - SCOPUS:85163795686

SN - 2072-6694

VL - 15

JO - Cancers

JF - Cancers

IS - 12

M1 - 3123

ER -

Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy

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