Extended lymph node dissection is associated with improved overall survival in patients with very high-risk prostate cancer: A national cancer database analysis
Sood A, Keeley J, Arora S, Dalela D, Jeong W, Rogers C, Peabody J, Menon M, and Abdollah F. Extended lymph node dissection is associated with improved overall survival in patients with very high-risk prostate cancer: A national cancer database analysis. Eur Urol Suppl 2019; 18(1):e2198.
Eur Urol Suppl
Introduction & Objectives: It is generally agreed that extended pelvic lymph node dissection (ePLND)provides valuable prognostic information and helps guide adjuvant therapy, however, its effect on survival has not been clearly elucidated. In this study, we sought to identify patients preoperatively that may derive a survival advantage from ePLND. Materials & Methods: Relying on the National Cancer Database, we identified all patients with prostate adenocarcinoma undergoing radical prostatectomy between the years 2004-2015. After excluding patients with clinical nodal/metastatic disease (n=2,568), prior radiotherapy, chemotherapy and hormonal therapy (n=10,931)or missing data (166,696), a final sample of 406,409 patients was achieved. Baseline patient and tumor characteristics, and survival data were noted. To analyze the impact ePLND (10+ LNs)versus none/limited PLND (0-9 LNs)on 10-yr overall survival, interaction between Godoy-nomogram predicted LNI (lymph node invasion)probability and ePLND/PLND was plotted using locally-weighted methods controlling for age and comorbidities. Results: The lines for ePLND and none/limited PLND separated at Godoy-nomogram predicted LNI of 20%, indicating that patients with a predicted LNI risk >20% will benefit from ePLND (Figure 1). Cox-regression analysis demonstrated that patients undergoing ePLND (HR=1.22, 95% CI 1.19 to 1.26)had 8% incrementally lower hazard of 10-yr mortality as compared to patients undergoing none/limited PLND (HR=1.31, 95% CI 1.29 to 1.33)for every 10% increment in Godoy-nomogram predicted LNI risk (p<0.0001). Conclusions: Our study is the first to demonstrate that ePLND may have survival benefit in addition to prognostic value in prostate cancer patients at high-risk for LNI. Further, we identify these patients preoperatively which may facilitate patient counseling and also potentially reduce over- and under-utilization of ePLND. [Figure Presented]