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Comparison of therapeutic features and oncologic outcome in patients with pN1 prostate cancer among robot-assisted, laparoscopic, or open radical prostatectomy

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Abstract

Objectives

To compare the therapeutic features and oncological outcomes of robot-assisted radical prostatectomy (RARP) with those of open radical prostatectomy (ORP) or laparoscopic radical prostatectomy (LRP) in lymph node (LN) positive prostate cancer patients in a retrospective observational multi-institutional study.

Patients and methods

We evaluated the clinical results of 561 patients across 33 institutions who underwent RARP, LRP, or ORP and who were diagnosed with LN-positive prostate cancer during RP with pelvic LN dissection (PLND). We determined the following survival outcomes: metastasis-free survival, overall survival, cancer-specific survival, and biochemical recurrence-free survival. The Kaplan–Meier method, log-rank test, and Cox proportional hazards regression model were used to evaluate the effect of treatment on oncological outcomes. Statistical significance was set at P < 0.05.

Results

There was no significant difference for any of the survival outcomes between the three surgical groups. However, RARP achieved a greater LN yield compared to that of ORP or LRP. When the extent of PLND was limited to the obturator LNs, the number of removed LNs (RLNs) was comparable between the three surgical groups. However, higher numbers of RLNs were achieved with RARP compared to the number of RLNs with ORP (P < 0.001) when PLND was extended to the external and/or internal iliac LNs.

Conclusion

RARP, LRP, and ORP provided equal surgical outcomes for pN1 prostate cancer, and the prognosis was relatively good for all procedures. Increased numbers of RLNs may not necessarily affect the oncological outcome.

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Data availability

The datasets generated and/ or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Koo KC, Tuliao P, Yoon YE et al (2014) Robot-assisted radical prostatectomy in the Korean population: a 5-year propensity-score matched comparative analysis versus open radical prostatectomy. Int J Urol 21:781–785

    Article  Google Scholar 

  2. Hu JC, O’Malley P, Chughtai B et al (2017) Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy. J Urol 197:115–121

    Article  Google Scholar 

  3. Robertson C, Close A, Fraser C et al (2013) Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localized prostate cancer: a systematic review and mixed treatment comparison meta-analysis. BJU Int 112:798–812

    Article  Google Scholar 

  4. Cao L, Yang Z, Qi L et al (2019) Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore) 98:e15770

    Article  Google Scholar 

  5. Shiota M, Takamatsu D, Kimura T et al (2022) Radiotherapy plus androgen-deprivation therapy for PSA persistence in lymph node-positive prostate cancer. Cancer Sci 113:2386–2396

    Article  CAS  Google Scholar 

  6. Abdollah F, Gandaglia G, Suardi N et al (2015) More Extensive Lymph Node Dissection Improves Survival in Patients with Node-positive Prostate Cancer. Eur Urol 68:e37-38

    Article  Google Scholar 

  7. Washington SL 3rd, Cowan JE, Herlemann A et al (2021) Influence of pelvic lymph node dissection and node-positive disease on biochemical recurrence, secondary treatment, and survival after radical prostatectomy in men with prostate cancer. Prostate 81:102–108

    Article  CAS  Google Scholar 

  8. Epstein JI, Zelefsky MJ, Sjoberg DD et al (2016) A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score. Eur Urol 69:428–435

    Article  Google Scholar 

  9. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  Google Scholar 

  10. Banapour P, Elliott P, Jabaji R et al (2019) Safety and feasibility of outpatient robot-assisted radical prostatectomy. J Robot Surg 13:261–265

    Article  Google Scholar 

  11. Skarecky D, Shaw G, Warren A et al (2014) A multinational, multi-institutional study comparing positive surgical margins rates among 22393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol 66:450–456

    Article  Google Scholar 

  12. Smith JA Jr, Chan RC, Chang SS et al (2007) A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 178:2385–2389

    Article  Google Scholar 

  13. Silberstein JL, Su D, Glickman L et al (2013) A case-mix-adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons. BJU Int 111:206–212

    Article  Google Scholar 

  14. Laurila TA, Huang W, Jarrard DF (2009) Robotic-assisted laparoscopic and radical retropubic prostatectomy generate similar positive margin rates in low and intermediate risk patients. Urol Oncol 27:529–533

    Article  Google Scholar 

  15. Epstein JI (1996) Incidence and significance of positive margins in radical prostatectomy specimens. Urol Clin N Am 23:651–663

    Article  CAS  Google Scholar 

  16. Tilki D, Preisser F, Tennstedt P et al (2017) Adjuvant radiation therapy is associated with better oncological outcome compared with salvage radiation therapy in patients with pN1 prostate cancer treated with radical prostatectomy. BJU Int 119:717–723

    Article  CAS  Google Scholar 

  17. Briganti A, Blute ML, Eastham JH et al (2009) Pelvic lymph node dissection in prostate cancer. Eur Urol 55:1251–1265

    Article  Google Scholar 

  18. DiMarco DS, Zincke H, Sebo TJ et al (2005) The extent of lymphadenectomy for pTXN0 prostate cancer does not affect prostate cancer outcome in the prostate specific antigen era. J Urol 173:1121–1125

    Article  Google Scholar 

  19. Kim KH, Lim SK, Kim HY et al (2013) Extend vs standard lymph node dissection in robot-assisted radical prostatectomy for intermediate- or high-risk prostate cancer: a propensity-score-matching analysis. BJU Int 112:216–223

    Article  Google Scholar 

  20. Touijer KA, Sjoberg DD, Benfante N et al (2021) Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial. Eur Urol Oncol 4:532–539

    Article  Google Scholar 

  21. Lestingi JFP, Guglielmetti GB, Trinh QD et al (2021) Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial. Eur Urol 79:595–604

    Article  Google Scholar 

  22. Mohler JL, Antonarakis ES, Armstrong AJ et al (2019) Prostate Cancer, Version 2. 2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 17:479–505

    Article  CAS  Google Scholar 

  23. Abdollah F, Gandaglia G, Suardi N et al (2015) More extensive lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 67:212–219

    Article  Google Scholar 

  24. Gofrit ON, Zorn KC, Steinberg GD et al (2008) The Will Rogers phenomenon in urological oncology. J Urol 179:28–33

    Article  Google Scholar 

  25. Marra G, Valerio M, Heidegger I et al (2020) Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review. Eur Urol Oncol 3:565–581

    Article  Google Scholar 

  26. Bivalacqua TJ, Pierorazio PM, Gorin MA et al (2013) Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy. Urology 82:653–658

    Article  Google Scholar 

  27. Pierorazio PM, Gorin MA, Ross AE et al (2013) Pathological and oncologic outcomes for men with positive lymph nodes at radical prostatectomy: the Johns Hopkins Hospital 30-year experience. Prostate 73:1673–1680

    Article  Google Scholar 

  28. Withrow DR, DeGroot JM, Siemens DR et al (2011) Therapeutic value of lymph node dissection at radical prostatectomy: a population-based case-cohort study. BJU Int 108:209–216

    Article  Google Scholar 

  29. Joslyn SA, Konety BR (2006) Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 68:121–125

    Article  Google Scholar 

  30. Fossati N, Willemse PM, Van den Broeck T et al (2017) The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur Urol 72:84–109

    Article  Google Scholar 

Download references

Acknowledgements

We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Urology and Retroperitoneal Surgery, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Kirisawa, Eijiro Nakamura & Yoshiyuki Matsui

  2. Department of Urology, Kyushu University, Fukuoka, Japan

    Masaki Shiota & Masatoshi Eto

  3. Department of Urology, Jikei University, Tokyo, Japan

    Takahiro Kimura

  4. Department of Urology, Okayama University, Okayama, Japan

    Kohei Edamura

  5. Department of Urology, Nara Medical University, Kashihara, Japan

    Makito Miyake & Makito Miyake

  6. Division of Urology, Department of Surgery, Tottori University, Tottori, Japan

    Shuichi Morizane

  7. Department of Urology, Tsukuba University, Tsukuba, Japan

    Takayuki Yoshino

  8. Department of Urology, Kashiwa Hospital, The Jikei University, Chiba, Japan

    Akihiro Matsukawa

  9. Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan

    Ryuji Matsumoto

  10. Department of Urology, Niigata University, Niigata, Japan

    Takashi Kasahara

  11. Department of Urology, University of Toyama, Toyama, Japan

    Naotaka Nishiyama & Hiroshi Kitamura

Authors
  1. Takahiro Kirisawa
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  2. Masaki Shiota
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  15. Yoshiyuki Matsui
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Consortia

the Japanese Urological Oncology Group

  • Takahiro Kirisawa
  • , Masaki Shiota
  • , Takahiro Kimura
  • , Kohei Edamura
  • , Makito Miyake
  • , Shuichi Morizane
  • , Takayuki Yoshino
  • , Akihiro Matsukawa
  • , Ryuji Matsumoto
  • , Takashi Kasahara
  • , Naotaka Nishiyama
  • , Masatoshi Eto
  • , Hiroshi Kitamura
  • , Eijiro Nakamura
  •  & Yoshiyuki Matsui

Corresponding author

Correspondence to Yoshiyuki Matsui.

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Supplementary Information

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10147_2022_2278_MOESM1_ESM.pptx

Supplementary Table 1. Number of lymph node dissections according to surgical modality. Supplementary Table 2. The rate of cases stratified by the number of lymph nodes involved (LNI) according to surgical modality. Supplementary Figure 1. Kaplan–Meier curve for metastasis-free survival (MFS) according to surgical modality by the number of lymph nodes involved (LNI). (a) number of LNI = 1; (b) number of LNI ≥ 2. Supplementary Figure 2. Kaplan–Meier curve for different oncological outcomes between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND): (a) metastasis-free survival (MFS), (b) overall survival (OS), (c) cancer-specific survival (CSS), and (d) biochemical recurrence-free survival (BRFS). Supplementary Figure 3. Kaplan–Meier curves for different oncological outcomes between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) with limited pelvic lymph node dissection (PLND): (a) metastasis-free survival (MFS), (b) overall survival (OS), (c) cancer-specific survival (CSS), and (d) biochemical recurrence-free survival (BRFS). Supplementary Figure 4. Kaplan–Meier curve for postprostatectomy-persistent prostate-specific antigen (PSA) according to surgical modality

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Kirisawa, T., Shiota, M., Kimura, T. et al. Comparison of therapeutic features and oncologic outcome in patients with pN1 prostate cancer among robot-assisted, laparoscopic, or open radical prostatectomy. Int J Clin Oncol 28, 306–313 (2023). https://doi.org/10.1007/s10147-022-02278-7

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  • DOI: https://doi.org/10.1007/s10147-022-02278-7

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