13771
2012
eng
2012
article
1
2016-08-25
--
--
The Role of Adjuvant Hormonal Treatment after Surgery for Localized High-Risk Prostate Cancer: Results of a Matched Multiinstitutional Analysis
Introduction. To assess the role of adjuvant androgen deprivation therapy (ADT) in high-risk prostate cancer patients (PCa) after surgery. Materials and Methods. The analysis case matched 172 high-risk PCa patients with positive section margins or non-organ confined disease and negative lymph nodes to receive adjuvant ADT (group 1, n=86 ) or no adjuvant ADT (group 2, n=86). Results. Only 11.6% of the patients died, 2.3% PCa related. Estimated 5–10-year clinical progression-free survival was 96.9% (94.3%) for group 1 and 73.7% (67.0%) for group 2, respectively. Subgroup analysis identified men with T2/T3a tumors at low-risk and T3b margins positive disease at higher risk for progression. Conclusion. Patients with T2/T3a tumors are at low-risk for metastatic disease and cancer-related death and do not need adjuvant ADT. We identified men with T3b margin positive disease at highest risk for clinical progression. These patients benefit from immediate adjuvant ADT.
Advances in Urology
10.1155/2012/612707
urn:nbn:de:bvb:20-opus-137712
Advances in Urology Volume 2012 (2012), Article ID 612707, 6 pages. DOI: 10.1155/2012/612707
Maria Schubert
Steven Joniau
Paolo Gontero
Susanne Kneitz
Claus-Jürgen Scholz
Burkhard Kneitz
Alberto Briganti
R. Jeffery Karnes
Bertrand Tombal
Jochen Walz
Chao-Yu Hsu
Giansilvio Marchioro
Pia Bader
Chris Bangma
Detlef Frohneberg
Markus Graefen
Fritz Schröder
Paul van Cangh
Hein van Poppel
Martin Spahn
eng
uncontrolled
prostate cancer
eng
uncontrolled
adjuvant hormonal treatment
Chirurgie und verwandte medizinische Fachrichtungen
open_access
Urologische Klinik und Poliklinik
Förderzeitraum 2011
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/13771/Schubert_Advances_Urology_612707.pdf
19572
2016
eng
3
article
European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT)
1
--
2016-12-16
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Impact of lymph node burden on survival of high-risk prostate cancer patients following radical prostatectomy and pelvic lymph node dissection
Aim
To determine the impact of the extent of lymph node invasion (LNI) on long-term oncological outcomes after radical prostatectomy (RP).
Material and methods
In this retrospective study, we examined the data of 1,249 high-risk, non-metastatic PCa patients treated with RP and pelvic lymph node dissection (PLND) between 1989 and 2011 at eight different tertiary institutions. We fitted univariate and multivariate Cox models to assess independent predictors of cancer-specific survival (CSS) and overall survival (OS). The number of positive lymph node (LN) was dichotomized according to the most informative cutoff predicting CSS. Kaplan–Meier curves assessed CSS and OS rates. Only patients with at least 10 LNs removed at PLND were included. This cutoff was chosen as a surrogate for a well performed PNLD.
Results
Mean age was 65 years (median: 66, IQR 60–70). Positive surgical margins were present in 53.7% (n = 671). Final Gleason score (GS) was 2–6 in 12.7% (n = 158), 7 in 52% (n = 649), and 8–10 in 35.4% (n = 442). The median number of LNs removed during PLND was 15 (IQR 12–17). Of all patients, 1,128 (90.3%) had 0–3 positive LNs, while 126 (9.7%) had ≥4 positive LNs. Patients with 0–3 positive LNs had significantly better CSS outcome at 10-year follow-up compared to patients with ≥4 positive LNs (87 vs. 50%; p < 0.0001). Similar results were obtained for OS, with a 72 vs. 37% (p < 0.0001) survival at 10 years for patients with 0–3 vs. ≥4 positive LNs, respectively. At multivariate analysis, final GS of 8–10, salvage ADT therapy, and ≥4 (vs. <4) positive LNs were predictors of worse CSS and OS. Pathological stage pT4 was an additional predictor of worse CSS.
Conclusion
Four or more positive LNs, pathological stage pT4, and final GS of 8–10 represent independent predictors for worse CSS in patients with high-risk PCa. Primary tumor biology remains a strong driver of tumor progression and patients having ≥4 positive LNs could be considered an enriched patient group in which novel treatment strategies should be studied.
Frontiers in Surgery
2296-875X
10.3389/fsurg.2016.00065
urn:nbn:de:bvb:20-opus-195721
Frontiers in Surgery 2016, 3:65. doi: 10.3389/fsurg.2016.00065
true
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Lisa Moris
Thomas Van den Broeck
Lorenzo Tosco
Anthony Van Baelen
Paolo Gontero
Robert Jeffrey Karnes
Wouter Everaerts
Maarten Albersen
Patrick J. Bastian
Piotr Chlosta
Frank Claessens
Felix K. Chun
Markus Graefen
Christian Gratzke
Burkhard Kneitz
Giansilvio Marchioro
Rafael Sanchez Salas
Bertrand Tombal
Henk Van Der Poel
Jochen Christoph Walz
Gert De Meerleer
Alberto Bossi
Karin Haustermans
Francesco Montorsi
Hendrik Van Poppel
Martin Spahn
Alberto Briganti
Steven Joniau
eng
uncontrolled
high-risk prostate cancer
eng
uncontrolled
lymph node dissection
eng
uncontrolled
positive lymph node
eng
uncontrolled
prognosis
eng
uncontrolled
surgery
Medizin und Gesundheit
open_access
Urologische Klinik und Poliklinik
Import
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/19572/fsurg-03-00065.pdf