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Extent of pelvic lymph node dissection improves early oncological outcomes for patients with high-risk prostate cancer without lymph node involvement after robot-assisted radical prostatectomy

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Abstract

Background

We investigated the effect of the extent of pelvic lymph node dissection (LND) on biochemical recurrence (BCR) in patients with prostate cancer (PCa) without lymph node involvement (LNI) treated with robot-assisted radical prostatectomy (RARP).

Methods

We retrospectively analyzed data from 378 patients who underwent RARP with LND at our hospital between October 2010 and June 2019. The BCR-free survival rate was determined using Kaplan–Meier analysis, and Cox regression analysis was used to investigate BCR prognostic factors. The total score calculated from the D’Amico risk classification and the percentage of positive biopsy cores were used for analysis. Patients were classified into 3 BCR risk groups (low risk: 0–3 points, intermediate risk: 4–5 points, and high risk: 6–8 points).

Results

Limited LND was performed in 161 patients (42.6%), extended LND in 217 patients (57.4%), and BCR was confirmed in 66 patients (17.5%) after RARP. Both univariate and multivariate analyses showed no significant difference in the association between the extent of LND and BCR. The Kaplan–Meier curve for BCR generated using our risk classification for patients with PCa without LNI showed no significant association between the extent of LND and BCR in the low-risk group (p = 0.790). A significantly improved BCR-free survival was observed in the extended LND group among patients with PCa at intermediate risk or higher (p < 0.05).

Conclusion

According to our risk classification, BCR may be less likely to occur when extended LND is performed during RARP for patients with localized PCa at intermediate risk or higher.

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Acknowledgements

The authors thank the medical engineering, nursing, and anesthesia staff at the Tottori University Hospital.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan

    Shuichi Morizane, Masashi Honda, Ryutaro Shimizu, Panagiota Tsounapi, Shogo Teraoka, Tetsuya Yumioka, Noriya Yamaguchi, Bunya Kawamoto, Hideto Iwamoto, Katsuya Hikita & Atsushi Takenaka

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  1. Shuichi Morizane
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  2. Masashi Honda
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  3. Ryutaro Shimizu
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  4. Panagiota Tsounapi
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  11. Atsushi Takenaka
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Correspondence to Masashi Honda.

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Morizane, S., Honda, M., Shimizu, R. et al. Extent of pelvic lymph node dissection improves early oncological outcomes for patients with high-risk prostate cancer without lymph node involvement after robot-assisted radical prostatectomy. Int J Clin Oncol 27, 781–789 (2022). https://doi.org/10.1007/s10147-022-02121-z

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