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Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer

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Abstract

Background

We investigated prognostic factors for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node (LN) dissection.

Methods

We included 173 patients who underwent RARP with extended pelvic LN dissection without neoadjuvant therapy at our hospital between October 2010 and April 2018. BCR was defined as prostate serum antigen (PSA) levels ≥ 0.2 ng/mL; BCR-free survival rates were determined using Kaplan–Meier analysis. We used Cox regression analysis to evaluate effects of PSA and pathologic variables on BCR.

Results

Median follow-up was 27.9 (range 6.1–86.9) months. Five-year BCR-free survival was 89.5%. In multivariate analysis, positive LNs (HR 7.117; 95% CI 2.826–17.925; P < 0.001) and Gleason score (GS) ≥ 8 (HR 2.612; 95% CI 1.051–6.489; P = 0.039) were significant predictors of BCR. Patients with 1 or 2 positive LNs (n = 10) had significantly higher BCR-free survival rates than patients with ≥ 3 positive LNs (n = 5). We, therefore, stratified the patients as low-risk (GS < 8 and no positive LNs), intermediate-risk: (either GS ≥ 8 or positive LNs) and high-risk (both GS ≥ 8 and positive LNs). Their 1-year BCR-free survival rates were low-risk: 94.6%, intermediate-risk: 88.5%, and high-risk: 33.3% (P < 0.05).

Conclusions

Patients with 1–2 positive LNs and GS < 8 have low risk for BCR; close observation without immediate adjuvant hormonal therapy can be considered for these patients.

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Acknowledgements

The authors thank the nursing, medical engineering and anesthesia staffs at Tottori University Hospital. We also thank Marla Brunker, from Edanz Group (https://www.edanzediting.com/ac), for editing a draft of this manuscript.

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Authors and Affiliations

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

    Shuichi Morizane, Masashi Honda, Ryutaro Shimizu, Shogo Teraoka, Ryoma Nishikawa, Panagiota Tsounapi, Yusuke Kimura, 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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Correspondence to Shuichi Morizane.

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Morizane, S., Honda, M., Shimizu, R. et al. Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer. Int J Clin Oncol 25, 1398–1404 (2020). https://doi.org/10.1007/s10147-020-01682-1

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  • DOI: https://doi.org/10.1007/s10147-020-01682-1

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