Artigo Acesso aberto Revisado por pares

Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate Cancer

2012; Lippincott Williams & Wilkins; Volume: 189; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2012.10.027

ISSN

1527-3792

Autores

Sigrid Carlsson, Laura J. Tafe, Daher C. Chade, Daniel D. Sjoberg, Niccolò Passoni, Shahrokh F. Shariat, James A. Eastham, Peter T. Scardino, Samson W. Fine, Karim Touijer,

Tópico(s)

Statistical Methods in Clinical Trials

Resumo

No AccessJournal of UrologyAdult Urology1 Apr 2013Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate Cancer Sigrid V. Carlsson, Laura J. Tafe, Daher C. Chade, Daniel D. Sjoberg, Niccolo Passoni, Shahrokh F. Shariat, James Eastham, Peter T. Scardino, Samson W. Fine, and Karim A. Touijer Sigrid V. CarlssonSigrid V. Carlsson Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Sahlgrenska Academy at University of Goteborg, Goteborg, Sweden , Laura J. TafeLaura J. Tafe Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York , Daher C. ChadeDaher C. Chade Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York , Daniel D. SjobergDaniel D. Sjoberg Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York , Niccolo PassoniNiccolo Passoni Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, Weill Medical College of Cornell University, New York, New York , James EasthamJames Eastham Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Weill Medical College of Cornell University, New York, New York , Peter T. ScardinoPeter T. Scardino Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Weill Medical College of Cornell University, New York, New York , Samson W. FineSamson W. Fine Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York , and Karim A. TouijerKarim A. Touijer Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Weill Medical College of Cornell University, New York, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2012.10.027AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Subclassification of nodal stage may have prognostic value in men with lymph node metastasis at radical prostatectomy. We explored the role of extranodal extension, size of the largest metastatic lymph node and the largest metastasis, and lymph node density as predictors of biochemical recurrence. Materials and Methods: We reviewed pathological material from 261 patients with node positive prostate cancer. We examined the predictive value when adding the additional pathology findings to a base model including extraprostatic extension, seminal vesicle invasion, radical prostatectomy Gleason score, prostate specific antigen and number of positive lymph nodes using the Cox proportional hazards regression and Harrell concordance index. Results: The median number of lymph nodes removed was 14 (IQR 9, 20) and the median number of positive lymph nodes was 1 (IQR 1, 2). At a median followup of 4.6 years (IQR 3.2, 6.0) 155 of 261 patients experienced biochemical recurrence. The mean 5-year biochemical recurrence-free survival rate was 39% (95% CI 33–46). Median diameter of the largest metastatic lymph node was 9 mm (IQR 5, 16). On Cox regression radical prostatectomy specimen Gleason score (greater than 7 vs 7 or less), number of positive lymph nodes (3 or greater vs 1 or 2), seminal vesicle invasion and prostate specific antigen were associated with significantly increased risks of biochemical recurrence. On subset analysis metastasis size significantly improved model discrimination (base model Harrell concordance index 0.700 vs 0.655, p = 0.032). Conclusions: Our study confirms that the number of positive lymph nodes is a predictor of biochemical recurrence in men with node positive disease. The improvement in prognostic value of measuring the metastatic focus warrants further investigation. References 1 : Staging of prostate cancer. Histopathology2012; 60: 87. Google Scholar 2 : Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases. Prostate2009; 69: 352. 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Link, Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byDraulans C, Everaerts W, Isebaert S, Van Bruwaene S, Gevaert T, Oyen R, Joniau S, Lerut E, De Wever L, Laenen A, Weynand B, Defraene G, Vanhoutte E, De Meerleer G and Haustermans K (2019) Development and External Validation of a Multiparametric Magnetic Resonance Imaging and International Society of Urological Pathology Based Add-On Prediction Tool to Identify Prostate Cancer Candidates for Pelvic Lymph Node DissectionJournal of Urology, VOL. 203, NO. 4, (713-718), Online publication date: 1-Apr-2020.Zareba P, Eastham J, Scardino P and Touijer K (2017) Contemporary Patterns of Care and Outcomes of Men Found to Have Lymph Node Metastases at the Time of Radical ProstatectomyJournal of Urology, VOL. 198, NO. 5, (1077-1084), Online publication date: 1-Nov-2017.Seiler R, Studer U, Tschan K, Bader P and Burkhard F (2013) Removal of Limited Nodal Disease in Patients Undergoing Radical Prostatectomy: Long-Term Results Confirm a Chance for CureJournal of Urology, VOL. 191, NO. 5, (1280-1285), Online publication date: 1-May-2014.Taneja S (2013) Re: Pathological and Oncologic Outcomes for Men with Positive Lymph Nodes at Radical Prostatectomy: The Johns Hopkins Hospital 30-Year ExperienceJournal of Urology, VOL. 191, NO. 2, (361-361), Online publication date: 1-Feb-2014. Volume 189Issue 4April 2013Page: 1314-1319 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsprostateprognosislymph node dissectionneoplasm recurrenceprostatic neoplasmsMetricsAuthor Information Sigrid V. Carlsson Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Sahlgrenska Academy at University of Goteborg, Goteborg, Sweden More articles by this author Laura J. Tafe Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Daher C. Chade Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Daniel D. Sjoberg Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Niccolo Passoni Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Shahrokh F. Shariat Department of Urology, Weill Medical College of Cornell University, New York, New York More articles by this author James Eastham Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Weill Medical College of Cornell University, New York, New York More articles by this author Peter T. Scardino Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Weill Medical College of Cornell University, New York, New York More articles by this author Samson W. Fine Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Karim A. Touijer Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Department of Urology, Weill Medical College of Cornell University, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ...

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