Abstract
Objective Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy (RP).Methods 75,583 patients undergoing RP with or without PLND between 2010 and 2016 were extracted from the Surveillance Epidemiology and End Results database. We performed 1:1 propensity score matching due to potential differences according to the 2 cohorts. Cox regression models (CRMs) were used to test the effect of PLND on overall mortality (OM) and cancer-specific mortality (CSM). Logistic regression analysis was used to investigate the predictors of LNI.Results The propensity-score-matched cohort includes 52,314 patients with or without PLND. Kaplan Meier analysis confirmed that patients receiving PLND had a poorer prognosis than those without PLND (P<0.05). But the multivariable CRMs after adjustment showed that PLND was not an independent predictor for OM and CSM (P>0.05). According to multivariable CRMs, patients with locally advanced PCa in whom PLND was performed had higher OM (HR 1.67, CI 1.36-2.06) and CSM (HR 2.26, CI 1.16-3.12) risks compared to patients without PLND (p < 0.001). Compared to patients with intermediate-risk PCa, there was a higher risk of LNI in patients with locally advanced PCa (OR 16.82, 95% CI 5.05-56.06, P<0.001).Conclusions In the intermediate- or high-risk localised PCa, there was no significant difference in survival outcome in patients with or without PLND. Locally advanced PCa was significantly associated with LNI but can’t benefit from PLND.
Extended lymph node dissection for intermediate and high-risk prostate cancer: do we have all the evidence?