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The significance of micro-lymphatic invasion and pathological Gleason score in prostate cancer patients with pathologically organ-confined disease and negative surgical margins after robot-assisted radical prostatectomy

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Abstract

Background

The development process of recurrence in prostate cancer patients with pathologically organ-confined (pT2) disease and negative surgical margins is unclear. The aim of the present study was to determine factors associated with the development of biochemical recurrence following robot-assisted radical prostatectomy among those prostate cancer patients.

Methods

We retrospectively reviewed the data of patients who underwent robot-assisted radical prostatectomy without neoadjuvant endocrine therapy. We evaluated prognostic factors in 1096 prostate cancer patients with pT2 disease and negative surgical margins. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent predictors for biochemical recurrence.

Results

Of the 1096 patients, 55 experienced biochemical recurrence during the follow-up period. The 5-year biochemical recurrence-free survival rate for patients with pT2 and negative surgical margins was 91.8%. On univariate analysis, clinical stage, biopsy Gleason score, percent of positive core, pathological Gleason score, and the presence of micro-lymphatic invasion were significantly associated with biochemical recurrence. On a multivariate analysis, the presence of micro-lymphatic invasion and a pathological Gleason score ≥ 4 + 3 were significant prognostic factors for biochemical recurrence. Based on these factors, we developed a risk stratification model. The biochemical recurrence-free survival rate differed significantly among the risk groups.

Conclusions

The prognosis of prostate cancer patients with pT2 disease and negative surgical margins is favorable. However, patients with the presence of micro-lymphatic invasion and a pathological Gleason score ≥ 4 + 3 tend to experience biochemical recurrence more often after surgery. Therefore, careful follow-up might be necessary for those patients.

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Authors and Affiliations

  1. Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Takeshi Hashimoto, Yuri Yamaguchi, Takeshi Kashima, Naoya Satake, Yoshihiro Nakagami, Kazunori Namiki & Yoshio Ohno

  2. Department of Urology, Sanno Hospital, Tokyo, Japan

    Jun Nakashima

  3. Clinical Medicine Research Center, International University of Health and Welfare, Tokyo, Japan

    Jun Nakashima

  4. Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan

    Rie Inoue & Toshitaka Nagao

  5. Department of Computer and Information Science, Seikei University, Tokyo, Japan

    Osamu Komori

  6. School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan

    Osamu Komori

Authors
  1. Takeshi Hashimoto
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  2. Jun Nakashima
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  3. Rie Inoue
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  4. Osamu Komori
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  5. Yuri Yamaguchi
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  6. Takeshi Kashima
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  7. Naoya Satake
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  8. Yoshihiro Nakagami
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  9. Kazunori Namiki
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  10. Toshitaka Nagao
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  11. Yoshio Ohno
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Correspondence to Takeshi Hashimoto.

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Hashimoto, T., Nakashima, J., Inoue, R. et al. The significance of micro-lymphatic invasion and pathological Gleason score in prostate cancer patients with pathologically organ-confined disease and negative surgical margins after robot-assisted radical prostatectomy. Int J Clin Oncol 25, 377–383 (2020). https://doi.org/10.1007/s10147-019-01561-4

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  • DOI: https://doi.org/10.1007/s10147-019-01561-4

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