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Positive node burden rather than the number of removed nodes impacts survival in patients with node-positive prostate cancer

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Abstract

Background

The value of pelvic lymphadenectomy during radical prostatectomy (RP) remains controversial. This study aims to test the effects of the number of removed lymph nodes (RLN), positive nodes (pLN), and pLN ratio (pLNR) on cancer-specific survival (CSS) in patients with node-positive prostate cancer (PCa).

Methods

A total of 2458 patients with a greater than 5% probability of lymph node invasion according to the updated Briganti nomogram who harboured pathologically confirmed positive nodes in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were identified. Multivariable Cox regression with forward stepwise selection was performed to identify independent risk factors for CSS. Maximally selected rank statistics were used to determine the most informative cut-off value for pLN and pLNR.

Results

The median pLN counts and RLN in the study were two (interquartile range [IQR] 1– 3) and 18 (IQR 15–23), respectively. The RLN counts could not predict CSS, while the higher pLN and pLNR were associated with worse CSS (hazard ratio [HR], 1.11; p < 0.001 and HR, 1.01; p < 0.001, respectively). Patients with ≤ 2 pLN or pLNR ≤ 20% had significantly better CSS than those with pLN > 2 or pLNR > 20% (HR, 1.38 (1.08–1.77); p = 0.009; HR, 1.77 (1.41–2.22); p < 0.001, respectively).

Conclusions

In patients with node-positive PCa, pelvic lymphadenectomy provides important information for staging, prognosis, and guiding after RP therapy; however, it does not play a therapeutic role. The pLN counts and pLNR were independent predictors of CSS.

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Acknowledgements

We would like to thank the reviewers and the editor for the positive and constructive comments and suggestions.

Funding

This study is supported by the Capital Clinical Characteristic Application Research (Grant No. Z171100001017201), Beijing Hospital Clinical Research 121 Project(Grant No. BJ-2018-090)

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Authors and Affiliations

  1. Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China

    Xiao-xiao Guo, Hui-min Hou, Xuan Wang, Jian-ye Wang & Ming Liu

  2. Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, China

    Xiao-xiao Guo, Hui-min Hou, Xuan Wang, Jian-ye Wang & Ming Liu

  3. Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China

    Run-qi Guo

  4. Peking Union Medical College, Beijing, China

    Xiao-xiao Guo

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  1. Xiao-xiao Guo
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  2. Run-qi Guo
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  3. Hui-min Hou
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  4. Xuan Wang
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  5. Jian-ye Wang
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  6. Ming Liu
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Correspondence to Xiao-xiao Guo or Ming Liu.

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Guo, Xx., Guo, Rq., Hou, Hm. et al. Positive node burden rather than the number of removed nodes impacts survival in patients with node-positive prostate cancer. Int J Clin Oncol 25, 2115–2121 (2020). https://doi.org/10.1007/s10147-020-01758-y

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  • DOI: https://doi.org/10.1007/s10147-020-01758-y

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