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

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.

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

2014 ◽  
Vol 67 (9) ◽  
pp. 787-791 ◽  
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.

1949 LYMPH NODE YIELD USING THE STANDARD LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY

2010 ◽  
Vol 183 (4S) ◽  
Author(s):  
Guilherme Godoy ◽  
Christian von Bodman ◽  
Daher Chade ◽  
Kinjal Vora ◽  
Ozdal Dillioglugil ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Lymph Node Yield ◽  
Node Yield

scholarly journals Applied Anatomy of Pelvic Lymph Nodes and Its Clinical Significance for Prostate Cancer:A Single-Center Cadaveric Study

2019 ◽  
Author(s):  
Chen Jia-Jun ◽  
Zhu Zai-Sheng ◽  
Zhu Yi-Yi ◽  
Shi Hong-Qi
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Adult Male ◽  
Pelvic Lymph Node Dissection ◽  
Node Dissection ◽  
Lymph Node Count ◽  
Pelvic Lymph Nodes ◽  
Node Count

Abstract Background Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers. Methods All 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed. Results A total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by local PLND was 4-22 (14.1±4.5), the number obtained by standard PLND was 16-35 (25.9±5.6), the number obtained by extended PLND was 17-44 (30.0±7.0), and the number obtained by super-extended PLDN was 24-60 (42.2±9.7). Conclusions There are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.

PS02.093: LYMPH NODE METASTASES IN T1 OESOPHAGEAL ADENOCARCINOMA: WHAT IS THE REAL RISK IN EARLY OESOPHAGEAL CANCER?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 147-147
Author(s):  
David Mitchell ◽  
Gregory Falk ◽  
Sashi Yeluri
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Oesophageal Cancer ◽  
Oesophageal Adenocarcinoma ◽  
Endoscopic Management ◽  
Lymph Node Yield ◽  
Node Metastasis ◽  
Node Yield ◽  
Positive Lymph Nodes

Abstract Background Lymph node status is regarded as the most important factor for prognosis for oesophageal cancer. T1 oesophageal adenocarcinoma management has shifted from oesophagectomy only to include endoscopic management as part of the algorithm, with some bodies (National Comprehensive Cancer Network (NCCN) 2016) recommending it for management of T1a disease and selected T1b disease. We reviewed the literature to assess the true risk of lymph node metastasis in patients with T1 oesophageal adenocarcinoma. Methods Medline, Embase, Pubmed and Cochrane where searched for manuscripts in english reviewing the lymph node metastasis in superficial (T1) oesophageal adenocarcinoma. The main outcome was reviewing the risk of lymph node metastasis in T1a and T1b oesophageal adenocarcinoma. Secondary outcomes looked at the rate of lymph node metastasis for T1b cancers based on degree of submucosal involvement (SM1, SM2 and SM3). Studies were excluded if neo-adjuvant chemotherapy or radiotherapy were received and if the surgical lymph node yield was < 15 lymph nodes. Results 38 Studies were identified. 22 studies were excluded due to low lymph node yield (< 15) or insufficient statistical analysis. For the 16 studies, a total of 1422 cases were included. 533 patients had T1a adenocarcinoma with 11 patients demonstrating positive lymph nodes (2%). 849 had T1b adenocarcinoma with 189 patients demonstrating positive lymph nodes (22%). Eight Studies did subgroup analysis of T1b lesions with a total of 365 patients identified. The rate of lymph node positivity for SM1, SM2 and SM3 was 17.9%, 16.6% and 29.6% respectively. Conclusion Early oesophageal adenocarcinoma (T1) is increasing in prevalence due to surveillance of pre-malignant conditions (Barrett's Oesophagus). Recently some bodies recommend the use of endoscopic mucosal resection as first line therapy for T1a disease. It is important to inform our patients the risk of lymph node metastasis is low but significant (2%). Given in specialised units, oesophagectomy can be performed with low mortality (< 1%) and morbidity with good quality of life it is justifiable to recommend oesophagectomy or endoscopic management in patients who are fit enough for surgery. For T1b disease an oesophagectomy is the gold standard of treatment given the significant risk of lymph node positivity (22%). Disclosure All authors have declared no conflicts of interest.

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