Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesicle invasion and node-negative disease

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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Proposing prognostic thresholds for lymph node yield in clinically lymph node-negative and lymph node-positive cancers of the oral cavity

Cancer ◽

10.1002/cncr.30227 ◽

2016 ◽

Vol 122 (23) ◽

pp. 3624-3631 ◽

Cited By ~ 25

Author(s):

Phoebe Kuo ◽

Saral Mehra ◽

Julie A. Sosa ◽

Sanziana A. Roman ◽

Zain A. Husain ◽

...

Keyword(s):

Lymph Node ◽

Oral Cavity ◽

Lymph Node Yield ◽

Node Negative ◽

Node Positive ◽

Lymph Node Positive ◽

Node Yield

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Clinical risk-based associations of lymph node dissection and detection of metastasis among men treated with radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.284 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 284-284

Author(s):

Alejandro Abello ◽

Patrick Aloysius Kenney ◽

Michael Leapman

Keyword(s):

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Node Metastasis ◽

Node Dissection ◽

Risk Status ◽

Lymph Node Yield ◽

Lymph Node Count ◽

Node Metastasis ◽

Node Count ◽

Node Yield

284 Background: Pelvic lymph node dissection (PLND) is recommended for most men at risk for lymph node involvement at the time of radical prostatectomy (RP) yet is frequently omitted. We aimed to examine the probability of PLND based on clinical risk status, and evaluate the impact of increasing lymph node yield on cancer detection rate across risk strata. Methods: We queried the National Cancer Database from 2004 to 2014 to identify patients with clinically localized PCa who underwent RP as their primary treatment. We extracted patient clinical and sociodemographic variables. Risk status was assessed using UCSF Cancer of the Prostate Risk Assessment (CAPRA) score. We fit conditional logistic regression models to estimate likelihood of PLND and incremental value of increasing lymph node count by risk strata. Results: We identified 698,728 men with PCa treated with RP including 380.201 (54.41%) whit PLND. Mean age at diagnosis was 62.6. PLND was omitted (Nx) in 56.1% of patients with low CAPRA-risk disease, 31.44% with intermediate and 24.72% high. Proportion of patients with >30 lymph nodes removed decreased from 9.3% on 2004 to 3.64% on 2014. Adjusting for clinical and pathologic factors, treatment in a community versus academic (Odds Ratio, OR=1.62, 95% CI 1.59-1.66; P <0.001) and black race (OR=1.13, 95% CI 1.09-1.17, P: 0.01) was associated with pNx status. Increasing lymph node count was independently associated with greater likelihood of detection of lymph node metastasis in all risk strata (11-20 nodes: OR: 3.13 , 95% CI 2.90-3.37, P<0.001; 20-30 nodes: OR: 5.07 , 95% CI 4.50-5.73, P<0.001; >30 nodes OR: 6.58, 95% CI 5.38-8.05, P<0.001) including patients with CAPRA-0 (11-20 nodes: OR: 3.28 , 95% CI 3.06-3.53, P<0.001; 20-30 nodes: OR: 5.77, 95% CI 5.16-6.45, P<0.001; >30 nodes OR: 7.90, 95% CI 6.56-9.51, P<0.001). Conclusions: PLND continues to be omitted in a substantial proportion of intermediate and high risk patients. Increasing lymph node yield was associated with greater odds of detecting lymph node metastasis in all groups of patients, including those at the lowest level of risk by clinical criteria.

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Benefit on Biochemical Control of Adjuvant Radiation Therapy in Patients with Pathologically Involved Seminal Vesicles after Radical Prostatectomy

Tumori Journal ◽

10.1177/030089160709300507 ◽

2007 ◽

Vol 93 (5) ◽

pp. 445-451 ◽

Cited By ~ 4

Author(s):

Carlo Greco ◽

Simona Castiglioni ◽

Andrei Fodor ◽

Ottavio De Cobelli ◽

Nadia Longaretti ◽

...

Keyword(s):

Radiation Therapy ◽

Radical Prostatectomy ◽

Seminal Vesicle ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Biochemical Failure ◽

Adjuvant Radiation ◽

Biochemical Control ◽

Adjuvant Radiation Therapy ◽

Seminal Vesicle Invasion

Aims and Background To determine whether there is a benefit for biochemical control with adjuvant radiation therapy to the surgical bed following radical prostatectomy in patients with seminal vesicle invasion and pathologically negative pelvic lymph nodes (pT3b-pT4 pN0). Methods We retrospectively reviewed the clinical records of radical prostatectomy patients treated between 1995 and 2002. A total of 66 patients with seminal vesicle invasion were identified: 45 of these patients received adjuvant radiation therapy and 21 were observed. Radiation therapy was initiated within 4 months of prostatectomy. Median dose was 66 Gy (range, 60–70 Gy). Median follow-up from the day of surgery was 40.6 months (mean, 41.5; range, 12–99). Biochemical recurrence was defined as the first value ≥0.2 ng/ml. Results At two years, the proportion of patients free from biochemical recurrence was 80% in patients who received adjuvant radiation therapy versus 54% for those not given radiation therapy (P = 0.036). Actuarial biochemical recurrence at 5 years was 59% vs 41% for the radiation therapy and no radiation therapy groups, respectively. On univariate Cox regression model, the hazard of biochemical failure was also associated with a detectable (≥0.2 ng/ml) postsurgical prostate-specific antigen (P = 0.02) prior to radiation therapy. Pathological T stage (pT3b vs pT4), Gleason score, primary Gleason pattern and positive surgical margins were not significantly associated with biochemical recurrence. The hazard of biochemical failure was around 85% lower in the radiation therapy group than in the observation group (P = 0.002). Conclusions Data from the present series suggest that adjuvant radiation therapy for patients with seminal vesicle invasion and undetectable (≤0.2 ng/ml) postoperative prostate-specific antigen significantly reduces the likelihood of biochemical failure.

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