Comparison of Biochemical Recurrence–Free Survival Between Periprostatic and Pelvic Lymph Node Metastases of Prostate Cancer

Abstract Background This study aimed to clarify the number of lateral pelvic lymph node metastases of colorectal cancer for which prognosis could be improved by dissection. Methods We analysed the data of 30 patients with lateral pelvic lymph node metastases of rectal cancer that underwent a total mesorectal excision with lateral pelvic lymph node dissection at our institute from 1986 to 2016. We performed survival analysis on the number of lateral pelvic lymph node metastases in each of these patients and identified an optimal cut-off point of the number of lateral pelvic lymph node metastases that would predict recurrence-free survival using the receiver operating characteristic curves and an Akaike information criterion value. Results The 5-year recurrence-free survival and overall survival of patients with one or two lateral pelvic lymph node metastases were significantly better than that of those with three or more (5-year recurrence-free survival, 63.3 vs. 0.0%, respectively; hazard ratio, 0.23; 95% CI, 0.07–0.72; P = 0.0124) (5-year overall survival, 68.2 vs. 15.6%, respectively; hazard ratio, 0.29; 95% CI, 0.09–0.92; P = 0.0300). All of the metastatic lateral pelvic lymph nodes in the group with one or two lateral pelvic lymph node metastases were restricted to the internal iliac artery or obturator nerve regions. Conclusions The cut-off number of lateral pelvic lymph node metastases in the internal iliac artery or obturator nerve regions of colorectal cancer cases in whom prognosis was improved by lateral pelvic lymph node dissection was 2; patients who had <3 lateral pelvic lymph node metastases had better prognoses than those with ≥3 lateral pelvic lymph node metastases.

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Incidence, distribution, and outcomes of node positive patients at radical prostatectomy: Manitoba Prostate Center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.162 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 162-162

Author(s):

Kamaljot Singh Kaler ◽

Tadeusz Jozef Kroczak ◽

Premal Patel ◽

Rebekah Rittberg ◽

Jeffery Walter Saranchuk ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Lymph Node Metastases ◽

Biochemical Recurrence ◽

Pelvic Lymph Node Dissection ◽

Pelvic Lymph Node ◽

Subspecialty Training ◽

Node Dissection ◽

Node Metastases

162 Background: Pelvic lymph node dissection at the time of radical retropubic prostatectomy (RRP) varies among surgeons and institutions. Differences focus on candidacy for node dissection and the limit of dissection. Standard lymph node dissection is typically above the obturator nerve to external iliac vessels. We analyzed our local experience of lymph node metastases at time of surgery. Methods: Data from the Manitoba Prostate Center were collected on consective patients undergoing RRP from January 2003 to June 2013 by two urologists with subspecialty training in oncology. Information extracted includes age, prostate-specific antigen (PSA), biochemical recurrence characteristics, and biopsy and pathological results. Results: Four hundred twenty consecutive patients comprised the data set and of whom 411 underwent a RRP and nine aborted prostatectomies. Average age of patients was 60 with an average preoperative PSA of 11. Overall lymph node metastases rate is 16.1%. Of the N1 patients, average number of positive nodes was 2.3. Average nodes removed for all patients were 13.4. Positive nodes on the right were found 53% of the time and 47% on the left. Locations of nodes are as follows: right external iliac, obturator, and hypogastric, 12%, 6%, and 19%, respectively; and for left external iliac, obturator, and hypogastric 9%, 3%, and 16%, respectively of all total nodes. One node was identified as other, and one surgeon sent packets as right pelvic and left pelvic with positive nodes 16% and 19% of all total positive nodes respectively. When looking at zones of a pelvic lymph node dissection separately, 54% are hypogastric, 13% obturator, and 33 external iliac. With an average of 37 months follow-up two patients with N1 disease died and only one from prostate cancer. Seventy nine percent had biochemical recurrence. Median time to treatment for biochemical recurrence was 4.5 months (0 to 33 months) with a median PSA of 0.28. Conclusions: This contemporary series of pelvic lymph node dissection with RRP represents high lymph node metastases (16%) relative to literature. Performing a limited pelvic lymph node dissection would under stage 54% of our patients. Despite high biochemical recurrence only one patient died of prostate cancer.

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