When the limited pelvic lymph node dissection in prostate cancer patients can be justified?
DOI:
https://doi.org/10.26641/2307-0404.2020.3.214848Abstract
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.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
How to Cite
Issue
Section
License
Copyright (c) 2020 Medicni perspektivi (Medical perspectives)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.
