Citations 1
Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy
Preißer, Felix , Incesu, Reha‐Baris , Rajwa, Paweł , Chłosta, Marcin , Ahmed, Mohamed E. , Cacciamani, Giovanni , Kretschmer, Alexander , Westhofen, Thilo , Smith, Joseph A. , Graefen, Markus , Calleris, Giorgio , Raskin, Yannic , Joniau, Steven , Sanchez‐Salas, Rafael , Gill, Inderbir S. , Karnes, R. Jeffrey , Cathcart, Paul, Poel, Henk G. van der , Marra, Giancarlo , Tilki, Derya , Ahmed, Mohamed , Cacciamani, Giovanni E , Kretschmer, Alexander , Calleris, Giorgio , Joniau, Steven , Karnes, Robert Jeffrey, Tilki, Derya , Gill, Inderbir S , Rajwa, Pawel , Marra, Giancarlo , Abreu, Andre Luis , Ribeiro, Luis, Gontero, Paolo , Shariat, Shahrokh F.
Cancers | June 9, 2023 | Volume: 15 | Issue: 12 | Pages: 3123
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.