Head-to-head comparison of lymph node density and number of positive lymph nodes in stratifying the outcome of patients with lymph node-positive prostate cancer submitted to radical prostatectomy and extended lymph node dissection

e17013 Background: The aim of this retrospective analysis is to evaluate the prognostic role of lymph node density (LND), i.e. the ratio of positive lymph nodes to the total number of lymph nodes removed during surgery, in nodal-positive cervical cancer patients. Methods: Out of 266 patients with cervical cancer that underwent surgery including lymphonodectomy between 2000 and 2017 at the Department for Gynecology and Obstetrics of the University Hospital Ulm, 86 patients with positive lymph nodes were included in the analysis. According to former study results, patients were divided into two groups with LND < 10% vs. ≥ 10%. Univariable and multivariable cox-regression models (adjusted for age, histological subtype, grading, body mass index, R-status, lymphangiosis, histologically confirmed FIGO-status and chemotherapy) were used to evaluate the association between LND and both overall survival (OS) and disease-free survival (DFS). Results: In the 86 patients, a median of 42 lymph nodes were removed (range 11 – 107), and a median of 2 lymph nodes (range 1 – 25) were found positive. 57 (66.3%) patients had a LND < 10% and 29 (33.7%) patients had a LND ≥ 10%. There was no significant association between LND (≥ 10% vs. < 10%) and OS in both univariable (hazard ratio[HR] 1.49, 95% CI 0.72 – 3.07, p = 0.280) and multivariable survival analysis (HR 1.46, 95% CI 0.64 – 3.32, p = 0.372), respectively. However, LND was significantly associated with DFS in univariable analysis (HR 2.11, 95% CI 1.10 – 4.03, p = 0.024) and was found to be an independent predictor for DFS in adjusted multivariable analysis (HR 2.30, 95% CI 1.08 – 4.91, p = 0.031). Conclusions: LND ≥ 10% in patients with lymph node-positive cervical cancer is associated with a worsened DFS compared to patients with a LND < 10%. Thus, LND may be used as an independent prognostic marker and/or for risk stratification in these patients.

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167 Prognostic value of lymph node density in prostate cancer node-positive patients treated with radical prostatectomy and pelvic lymph node dissection

European Urology Supplements ◽

10.1016/s1569-9056(14)60166-4 ◽

2014 ◽

Vol 13 (1) ◽

pp. e167-e167a

Author(s):

R. Schiavina ◽

E. Brunocilla ◽

M. Borghesi ◽

V. Vagnoni ◽

D. Romagnoli ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Node Dissection ◽

Prognostic Value ◽

Pelvic Lymph Node Dissection ◽

Node Dissection ◽

Node Density ◽

Lymph Node Density ◽

Node Positive

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Disease Progression in Bladder Cancer: Which Developments since 1994

Urologia Journal ◽

10.1177/039156030907600215 ◽

2009 ◽

Vol 76 (2) ◽

pp. 115-117

Author(s):

V. Varca ◽

A. Simonato ◽

P. Traverso ◽

A. Romagnoli ◽

F. Venzano ◽

...

Keyword(s):

Prostate Cancer ◽

Bladder Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Nodes ◽

Radical Cystectomy ◽

Public Awareness ◽

Locally Advanced ◽

Node Dissection ◽

Group 2

Objectives The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006. Methods 456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition. Results For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group. Conclusions Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.

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Pathological analysis of lymph nodes in anterior prostatic fat excised at robot-assisted radical prostatectomy

Journal of Clinical Pathology ◽

10.1136/jclinpath-2014-202303 ◽

2014 ◽

Vol 67 (9) ◽

pp. 787-791 ◽

Cited By ~ 8

Author(s):

J J Aning ◽

R Thurairaja ◽

D A Gillatt ◽

A J Koupparis ◽

E W Rowe ◽

...

Keyword(s):

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Node Dissection ◽

Robot Assisted ◽

Lymph Node Yield ◽

Extended Lymph Node Dissection ◽

Pathological Analysis ◽

Node Yield

AimsTo assess the lymph node content of anterior prostatic fat (APF) sent routinely at robot-assisted laparoscopic radical prostatectomy (RALP) and the incidence of positive nodes in the extended pelvic lymph node dissection.MethodsBetween September 2008 and April 2012, APF excised from 282 patients who underwent RALP was sent for pathological analysis. This tissue was completely embedded and lymph nodes counted.ResultsIn total, 49/282 (17%) patients had lymph nodes in the APF, median lymph node yield in this tissue was 1 (range 1–5). In four patients, the lymph nodes contained metastatic deposits. These patients did not have positive nodes elsewhere in the extended lymph node dissection.ConclusionsAPF contains lymph nodes in 1 in 6 patients and infrequently these may be malignant. APF should always be removed at radical prostatectomy. APF should be routinely sent for pathological analysis.

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How many lymph nodes may serve as a guideline for a sufficient extended lymph node dissection during radical prostatectomy?

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16102 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16102-e16102

Author(s):

G. Pomara ◽

G. Campo ◽

C. Milesi ◽

P. Casale ◽

F. Francesca

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Median Number ◽

Node Dissection ◽

Extended Lymph Node Dissection ◽

Experienced Surgeon ◽

Node Metastasis ◽

Positive Lymph Nodes

e16102 Background: Recent data suggest that extended lymph node (LN) dissection at radical prostatectomy (RP) may be necessary to detect occult positive lymph nodes, and that extended dissection may also have a positive impact on disease progression and long-term disease-free survival. However, evaluation of lymphadenectomy to be complete and sufficient as judged by the number of removed lymph nodes is sometimes difficult. Some authors reported that approximately 20 pelvic lymph nodes may serve as a guideline for a sufficient extended lymph node dissection during RP. The purposes of this study were 1) to assess the reproducibility of this number (20 LN) in experienced hands; 2) to evaluate the effect of the number of LNs removed on lymph node metastasis. Materials and Methods: Data from 293 consecutives patients undergone to RP with extended lymphadenectomy were prospectively analyzed [median age 66 (35–79), median PSA 7.98 ng/ml (2.5–35)]. The number of lymph nodes extracted and the number of patients with positive lymph nodes detected were analyzed and compared. Moreover we distinguished and analyzed RPs data of most experienced surgeon: 124 patients [median age 65aa (44–79), median PSA 6.7(2.5–19)]. Results: Analyzing all the population, the median number of removed lymph nodes was 15 (1–39). Analyzing only the most experienced surgeon results, the median number of removed lymph nodes was 20 (range 6–39). The effect of the number of LNs removed on lymph node metastasis is shown in the Table . Conclusions: Compared to limited lymph node dissection (< 10 removed LNs), extended pelvic lymphadenectomy appears to identify men with positive lymph nodes more frequently. Although very experienced surgeons remove approximately 20 pelvic lymph nodes (comparable to the literature), our results seem to underline that 15 removed LNs are sufficient as a guideline for an extended lymph node dissection during RP. [Table: see text] No significant financial relationships to disclose.

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