When the limited pelvic lymph node dissection in prostate cancer patients can be justified?

Authors

DOI:

https://doi.org/10.26641/2307-0404.2020.3.214848

Abstract

Extended pelvic lymph node dissection (PLND) is an important diagnostic step in the surgical treatment of moderate and high risk prostate cancer (PCa) according to D'Amico criteria. However, it has a number of complications and prolonged time of surgery. Limited PLND has a more favorable complication profile, but is not used because of its low diagnostic efficacy in low-risk RP patients, while in higher-risk groups its relevance remains controversial. The goal – to determine the diagnostic efficacy of limited PLND in radical prostatectomy in patients of moderate and high risk. A retrospective analysis included 377 PCa patients in whom the radical prostatectomy with PLND was performed in the period between 2013 and 2016. Patients' age was 63.4±6.2 y.o. 40 (10.6%) patients had low, 126 (33.4%) – moderate and 211 (56.0%) – high risk PCa. No statistically significant differences in the number of complications of PLND in open and laparoscopic surgery (p=0.16) were found. The overall frequency of complications was 22.8% (95% CI 18.6 - 27.1). When comparing clinical and histological parameters in groups with and without metastases, statistically significant differences were found between the levels of total prostate specific antigen before surgery (p=0.010); the Gleason score (corresponding median values of 8.0 (8.0; 9.0) and 7.0 (6.0; 7.0); p<0.001) and local tumor status (T) – the  patients with stage >T2  53.1% and 19.4%, respectively (p<0.001). In 32 (8.5%) patients metastatic lesions of lymphatic nodes were found. Of these, 28 (87.5%) were related to high- risk, 4 (12.5%) – to moderate- risk. The main prognostic criteria for lymph node metastasis are preoperative PSA level, the Gleason Score, and T-status of the tumor. According to ROC analysis, the diagnostic efficacy of limited PLND increases in patients at high and moderate risk at a total PSA level greater than 18.4 ng/ml. This can be used to justify the indications for limited PLND in patients in these groups to reduce the number of postoperative complications associated with extended procedure.

Author Biographies

R. M. Molchanov

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

E. O. Stakhovskyi

National Cancer Institute
M. Lomonosova str., 33/43, Kyiv, 03022, Ukraine

L. V. Kriachkova

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

Ye. V. Pilin

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

S. L. Malinovskyi

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

References

Leyh-Bannurah SR, et al. Adherence to pelvic lymph node dissection recommendations according to the National Comprehensive Cancer Network pelvic lymph node dissection guideline and the D’Amico lymph node invasion risk stratification. Urol Oncol. 2018;36(2):81.e17-81.e24. doi: http://dx.doi.org/10.1016/j.urolonc. 2017.10.022

Chalouhy C, Gurram S, and Ghavamian R. Cur­rent controversies on the role of lymphadenectomy for prostate cancer. Urol Oncol. 2019;37(3):219-26. doi: http://dx.doi.org/10.1016/j.urolonc.2018.11.020

Cimino S, et al. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol. 2017;51(5):345-50. doi: http://dx.doi.org/10.1080/21681805.2017.1332680

Briganti A, et al. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol. 2006;50(5):1006-13.

Bray F, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018;68(6):394-424.

Lang TA, Secic M. How to report statistics in medicine : annotated guidelines for authors, editors, and reviewers. 2nd ed. ed. 2006, New York: American College of Physicians. https://doi.org/10.2307/2669655

Mottet N, et al. EAU - EANM - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer; 2019. doi: https://doi.org/10.1016/j.eururo.2019.07.014

Ploussard G, et al. Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol. 2014;65(1):7-16. doi: http://dx.doi.org/10.1016/j.eururo.2013.03.057

Batra V, et al. Predictive factors for lymph node positivity in patients undergoing extended pelvic lym­phadenectomy during robot assisted radical pro­statectomy. Indian J Urol, 2015;31(3): 217-22. doi: https://doi.org/10.4103/0970-1591.156918

Banapour P, et al. Radical Prostatectomy and Pelvic Lymph Node Dissection in Kaiser Permanente Southern California: 15-Year Experience. Perm J, 2019;23. doi: http://dx.doi.org/10.7812/TPP/17-233

Sierra PS, et al. Robot-assisted extended pelvic lymph node dissection in prostate cancer. When and how? Arch Esp Urol. 2019;72(3):257-65. doi: https://doi.org/10.1016/s1569-9056(19)32519-9

Van der Poel HG, et al. Sentinel node biopsy and lymphatic mapping in penile and prostate cancer. Urologe A. 2017;56(1):13-17. doi: http://dx.doi.org/10.1007/s00120-016-0270-7

Šimundić AM. Measures of Diagnostic Ac­curacy: Basic Definitions. EJIFCC. 2009;19(4):203-11. doi: https://doi.org/10.1002/9780470317082.ch2

Fossati N, et al. The Benefits and Harms of Dif­fe­rent Extents of Lymph Node Dissection During Radical Pro­statectomy for Prostate Cancer: A Systematic Review. Eur Urol. 2017;72(1):84-109. doi: http://dx.doi.org/10.1016/j.eururo.2016.12.003

Vittinghoff E. Regression methods in biosta­tis­tics: linear, logistic, survival, and repeated measures models. New York: Springer; 2005.

Downloads

Published

2020-10-05

How to Cite

1.
Molchanov RM, Stakhovskyi EO, Kriachkova LV, Pilin YV, Malinovskyi SL. When the limited pelvic lymph node dissection in prostate cancer patients can be justified?. Med. perspekt. [Internet]. 2020Oct.5 [cited 2024Jul.20];25(3):124-31. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/214848

Issue

Section

CLINICAL MEDICINE