Impact Of Pelvic Lymphadenectomy On Disease-Free Survival After Radical Prostatectomy: A Multicenter Study

Main Category: Urology / Nephrology
Also Included In: Prostate / Prostate Cancer;  Clinical Trials / Drug Trials
Article Date: 25 May 2008 - 0:00 PDT

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UroToday.com - Extended pelvic lymphadenectomy (PLND) increases the yield of both total and positive lymph nodes (LN). Studies have also demonstrated that up to 40% of all LN metastasis are localized outside the region of the standard obturator and external iliac PLND. The aim of this study was to analyze the impact of PLND on PSA failure (PSAF).

The researchers retrospectively analyzed the databases of radical prostatectomies (RP) from three different Urological Departments. Center A performed only perineal prosatectomies (PP) with no PLND in patients with PSA <10ng/ml. The two others performed retropubic prostatectomy in all patients. Center B performed a standard PNLD and center C an extended PLND including internal and common iliac LN.

They performed a first analysis on 2,380 patients from the 3 cohorts with a PSA <10ng/ml and cT<3: 688, 889, and 803 from groups A, B and C respectively. Baseline demographic and pathological characteristics were different for the three cohorts with group C having higher risk patients. The median of LN removed was 0, 6 and 14 and LN+ 0%, 1.2% and 6% respectively. Cox regression multivariate analysis identified pre-operative PSA, p-stage, positive margins, pathologic Gleason score, neo- and adjuvant therapy as significant risk factors of PSAF all at p<0.0001. While adjusting for these variables the risk of PSAF was increased in patients with PP and no PLND (Group A) vs. extended PLND (Group C) but not vs. standard PLND (Group B). When analyzing the pN0 vs. pNx patients of PP in multivariate analysis, standard vs. no PLND did not reduce the risk of PSAF while extended POLND was associated with a risk reduction of 64%. They then compared the two complete cohorts B and C comprising 1,900 patients using Cox-regression multivariate analysis. Standard PLND was associated with 2 times more risk of PSAF (HR 2.11 p<.0001) compared to extended PLND. Type of PLND was a stronger independent predictor than p-Stage, Gleason >7 and positive margin.

This data suggests that the extent of PLND and particularly removal of internal iliac and common iliac nodes can reduce the risk of biochemical recurrence after RP.

Presented by Michele Lodde, MD, Helene Hovington, MD, Francois Harel, MD, Michael J Harris, MD, David P Wood, MD, Michel Hugues Lebel, MD, Luis Lacombe, MD, Yves Fradet, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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