RADICAL PROSTATECTOMY WITH EXTENDED PELVIC LYMPH NODE DISSECTION: SHORT-TERM ONCOLOGICAL OUTCOMES IN PATIENS WITH NODAL METASTASES. IS CURE POSSIBLE WITHOUT SYSTEMIC TREATMENT?
Authors:
Michal Staník 1; Jan Doležel 1,2; Ivo Čapák 1; Daniel Macík 1; Jiří Jarkovský 3; Eva Lžičařová 4; Marcela Vagundová 5; Martin Šustr 1; David Miklánek 1
Authors place of work:
Oddělení onkourologie, MOÚ Brno
1; Centrum robotické chirurgie Vysočina, Nemocnice sv. Zdislavy, Mostiště
2; Institut biostatistiky a analýz, Brno
3; Oddělení onkologické a experimentální patologie, MOÚ Brno
4; Cedelab, Laboratoř patologie a klinické cytologie, Nemocnice sv. Zdislavy, Mostiště
5
Published in the journal:
Ces Urol 2015; 19(2): 137-144
Category:
Original article
Summary
Radical prostatectomy with extended pelvic lymph node dissection: short-term oncological outcomes in patiens with nodal metastases. Is cure possible without systemic treatment?
Aims:
Lymph node metastasis is an unfavorable prognostic factor in prostate cancer. The benefit of pelvic lymph node dissection remains controversial. The aim of our study was to evaluate three-year oncological results and assess the potential of locoregional therapy consisting of radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). We also evaluated the 3-year survival rate in patients without androgendeprivation therapy (ADT).
Methods:
Eighty-six patients (64 MOÚ, 22 Mostiště) with nodal metastases who underwent RP + ePLND between August 2007 and March 2014 were included in this study. ePLND included a minimum of external iliac, obturator and internal iliac node dissection. Adjuvant or early salvage RT was performed in 69 (80 %) patients. Median follow-up was 30 months. The Kaplan-Meier model was used to evaluate the survival rate.
Results:
Stages pT2, pT3a, pT3b and pT4 were seen in 20 %, 23 %, 55 % and 2 % of the patients respectively. The median PSA was 14 ng/ml (IQR 8–23). The median number of removed and metastatic lymph nodes was 18 (IQR 14–22) and 2 (range 1–9) respectively. Three-year overall and cancerspecific survival was 93 % and 97 %. The proportion of patients without biochemical recurrence and with delayed ADT after three years was 66 % and 64 % respectively. Postoperatively, median PSA was 0,029 (IQR 0,007–0,135). A maximum of two positive lymph nodes (p = 0,048) and a postoperative PSA lower than 0,01 ng/ml (p = 0,018) were significantly associated with the risk of biochemical recurrence.
Conclusion:
Patients with nodal metastases comprise a heterogeneous group. In a subset with minimal nodal involvement, the locoregional treatment may be curative. The results imply that a substantial number of patients may benefit through delay in the biochemical recurrence and the need for ADT. Further studies are needed to better define the need for RT and ADT in this group of the patients.
Key words:
Antineoplastic agents-hormonal, lymph node excision, prostatic neoplasms, radiotherapy.
Zdroje
1. Eggener S, Scardino PT, Walsh PC, et al. Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol 2011; 185(3): 869–875.
2. Messing EM, Manola J, Yao J, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 2006; 7: 472–479.
3. Toujier KA, Mazzola CR, Sjoberg D, Scardino PT, Eastham JA. Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen deprivation therapy. Eur Urol 2014; 65: 20–25.
4. Seiler R, Studer UE, Tschan K, Bader P, Burkhard FC. Removal of limited nodal disease in patients undergoing radical prostatectomy: long-term results confirm a chance for cure. J Urol 2014; 191(5): 1280–1285.
5. Allan CA, Collins VR, Frydenberg M, McLachlan R, Matthiesson KL. Androgen deprivation therapy complications. Endocr Relat Cancer 2014; 21(4): T119–129.
6. Briganti A, Karnes JR, Da Pozzo LF, et al. Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2–4 pN+ prostate cancer: results of a matched analysis. Eur Urol 2011; 59(5): 832–840.
7. Staník M, Čapák I, Macík D, et al. Sentinel lymph node dissection combined with meticulous histology increases the detection rate of nodal metastases in prostate cancer. Int Urol Nephrol 2014; 46(8): 1543–1549.
8. Bolla M, van Poppel H, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2005; 366: 572–578.
9. Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 2009; 181: 956–962.
10. Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radiál prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96–02/AUO AP 09/95. J Clin Oncol 2009; 27: 2924–2930.
11. Golimbu M, Provet J, Al-Askari S, Morales P. Radical prostatectomy for stage D1 prostate cancer. Prognostic variables and results of treatment. Urology 1987; 30(5): 427–435.
12. Weinberg RA. The biology of cancer. 2. ed. New York: Garlan Science, Taylor & Francis Group, LLC 2014; 641–722.
13. Pal SK, He M, Wilson T, Liu X, Zhang K, et al. Detection and phenotyping of cirulating tumor cells in high-risk localized prostate cancer. Clin Genitourin Cancer 2014; doi: 10.1016/j.clgc.2014.08.014. V tisku.
14. Boorjian SA, Thompson RH, Siddiqui S, et al. Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol 2007; 178: 864–870.
15. Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014; 65(1): 124–137.
16. Fleischmann A, Schobinger S, Schumacher M, Thalmann GN, Studer UE. Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases. Prostate 2009; 69(4): 352–162.
17. Cheng L, Zincke H, Blute ML, et al. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer. 2001; 91(1): 66–73.
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2015 Číslo 2
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