767 Do Patients with Lymph Node Micrometastasis (≤ 2 mm) Show Better Disease-Free Survival Than Those with Macrometastasis (> 2 mm) in Prostate Cancer Following Radical Prostatectomy?

Document Type

Conference Proceeding

Publication Date

3-23-2026

Publication Title

Lab Invest

Keywords

adult, aged, cancer patient, cancer staging, cohort analysis, conference abstract, controlled study, distant metastasis, drug therapy, extranodal extension, female, follow up, human, lymph node, lymph node metastasis, major clinical study, male, metastasis, micrometastasis, overall survival, pelvis lymph node, preoperative treatment, prospective study, prostate cancer, radical prostatectomy, retrospective study, robot-assisted prostatectomy, surgery

Abstract

Disclosures: Priti Agarwal: None; Vipulkumar Dadhania: None; Oudai Hassan: None; Nilesh Gupta: None; Mohamed Alhamar: None Background: Prognosis of prostate cancer with pelvic lymph node (LN) metastasis is highly variable. The current TNM classification does not sub-stratify LN-positive (LN+) cases. We evaluated whether micrometastatic (≤2 mm) versus macrometastatic (>2 mm) nodal involvement influences outcomes, along with the prognostic significance of the number of positive LNs, Grade Group (GG) of the metastatic focus, and extranodal extension (ENE). Design: All LN+ robot-assisted radical prostatectomy (RP) cases with available follow-up data from 2007–2018 were reviewed. Patients who received preoperative therapy or had distant metastasis were excluded. Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan–Meier methods with log-rank testing, and multivariate analysis was performed using Cox proportional hazards models. Results: A total of 234 LN+ prostate cancer patients were included, with a median follow-up of 107 months (range, 7–218). Of these, 152 (65%) were alive without disease, 35 (15%) alive with disease, 30 (13%) died of prostate cancer, and 17 (7%) died of other causes. The median number of positive LNs was 1 (range, 1–22), the median size of the largest metastatic focus was 3 mm (range, 0.1–55), and 84 (36%) cases showed ENE. Table summarizes RP data. On Kaplan–Meier analysis (Figure 1), patients with LN micrometastasis (≤2 mm) had significantly better DFS compared to those with macrometastasis (>2 mm, p = 0.018). Shorter DFS was also associated with ≥2 positive LNs (p = 0.003) and higher metastatic GG (p = 0.042), whereas ENE was not significant (p = 0.36). On multivariate analysis (Figure 2), RP GG (GG5: HR = 8.03, p = 0.004) and macrometastates (HR = 6.76, p = 0.033) remained independent predictors of shorter DFS. Number of positive LNs, ENE, and metastatic GG were not independently significant. For OS, only age ≥64 years (HR = 2.38, p = 0.027) and RP GG (GG5: HR = 3.17, p = 0.019) were associated with worse outcomes. [Formula presented] [Formula presented] [Formula presented] Conclusions: Patients with LN micrometastasis (≤2 mm) demonstrated significantly better DFS compared to macrometastasis (>2 mm). In LN+ prostate cancer, higher RP Grade Group (GG 5) and macrometastases independently predicted shorter DFS, underscoring the prognostic importance of both primary and nodal tumor characteristics. Our findings support subclassifying LN metastases into micro- and macrometastasis categories, which may enhance postoperative risk stratification and guide surveillance. Validation in larger prospective studies is warranted.

Volume

106

Issue

3

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