Oncological outcome of patients treated with spot-specific salvage lymphnode dissection (sLND) for positron-emission tomography (PET)-positive prostate cancer (PCa) relapse
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To report pre-, postoperative and oncological outcomes in patients treated with spot-specific sLND for patients with exclusive nodal recurrence after PCa primary treatment.
Materials and methods
With regard to salvage treatment failure (sTF), 46 consecutive patients, undergoing 52 sLND for nodal recurrence detected by PET/CT scan were stratified in 3 groups (group A: post-sLND PSA nadir < 0.01 ng/ml and in follow-up reaching a value > 0.2 ng/ml, group B: post-sLND PSA nadir > 0.01 ng/ml and in follow-up reaching a value equal to pre-sLND PSA; group C: additional salvage treatment administration). Surgical outcome of patients was analyzed by descriptive statistics (Student‘s t test for continuous variables, Chi-square and Fisher‘s test for categorial ones). Time to sTF of each group was analyzed and compared by Kaplan–Meier method and correlations regarding sTF and pre-sLND PSA, time from PCa primary treatment to PET/CT scan, time from PCa primary treatment to sLND and number of positive PET/CT scan spots were assessed.
Median PSA at PET/CT scan was 2.9 ng/ml (IQR 1.2–6.1). Open and laparoscopic sLND were performed in 40/52 (77%) and 12/52 (23%), respectively. Median number of removed lymph nodes was 6 (IQR 4–13). Histological report was positive for PCa in 39/52 sLND (75%). Median blood loss was 50 ml (IQR 0–50, range 0–600). Median length of hospital stay was 5 days (IQR 4–6). 4 and 7 patients had low-grade (I/II) and high-grade (≥ III) Clavien–Dindo complications, respectively. Readmission rates at 30 and 90 days were 5/52 (9.6%) and 1/52 (2%), respectively. sTF was observed in 2/7 (group A), 12/12 (group B) and 22/22 patients (group C). Median time to sTF in group B and C was 3.5 (IQR 1.7–13.2) and 4 months (IQR 2.0–10), respectively.
Even spot-specific PET/CT sLND harbors a measurable (CD > III) morbidity in 1 out of 7 patients. Only patients with positive histological report and a PSA nadir < 0.01 ng/ml after sLND seem to experience a long-term benefit. Patients with a PSA nadir > 0.01 ng/ml have a delay of systemic treatment of up to 4 months. sLND remains an experimental approach and long-term oncological benefit needs an improved selection of patients.
KeywordsProstate cancer Nodal recurrence Salvage surgery PET/CT scan
AH: project development, data collection/management/analysis, manuscript writing. AN: project development, data collection/management/analysis, manuscript writing. GN: manuscript editing, data analysis. CA: manuscript editing, data analysis. HH: data management PET/CT, manuscript editing. CA: data management PET/CT. LS: data management CT; manuscript editing, data collection. PA: manuscript editing, data collection. RR: manuscript editing, data collection.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The current study has been approved by the institutional ethics review board (No. 2014082777).
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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