TY  - JOUR
A1  - Van Baelen, Anthony
A1  - Mottet, Nicolas
A1  - Spahn, Martin
A1  - Briganti, Alberto
A1  - Gontero, Paolo
A1  - Joniau, Steven
T1  - Sense and Nonsense of an Extended Pelvic Lymph Node Dissection in Prostate Cancer
JF  - Advances in Urology
N2  - Lymph node metastases associated with prostate cancer (PCa) has been shown to be a poor prognostic factor. The role of pelvic lymph node dissection (PLND) itself in relation to survival remains unclear, however. A Medline search was conducted to address this issue. The following conclusions were drawn. Only recently, improved survival due to completion of radical prostatectomy (RP) (compared to abandoning RP) in known or presumed lymph-node-positive patients has been shown. Lymph node sampling can only be considered representative if an adequate number of nodes is removed. While several authors have suggested that a therapeutic benefit in patients undergoing RP is not provided by PLND, the reliability of these studies is uncertain. Contrary to this, several studies have indicated the possibility of long-term survival even in the presence of limited lymph node metastases. The role and timing of initiation of adjuvant androgen deprivation therapy (ADT) in patients who have node-positive disease after RP is controversial. Recent studies suggest that delaying ADT may not adversely impact survival.
KW  - Prostatakrebs
Y1  - 2012
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-123990
VL  - 2012
IS  - 983058
ER  - 
TY  - JOUR
A1  - Moris, Lisa
A1  - Van den Broeck, Thomas
A1  - Tosco, Lorenzo
A1  - Van Baelen, Anthony
A1  - Gontero, Paolo
A1  - Karnes, Robert Jeffrey
A1  - Everaerts, Wouter
A1  - Albersen, Maarten
A1  - Bastian, Patrick J.
A1  - Chlosta, Piotr
A1  - Claessens, Frank
A1  - Chun, Felix K.
A1  - Graefen, Markus
A1  - Gratzke, Christian
A1  - Kneitz, Burkhard
A1  - Marchioro, Giansilvio
A1  - Salas, Rafael Sanchez
A1  - Tombal, Bertrand
A1  - Van Der Poel, Henk
A1  - Walz, Jochen Christoph
A1  - De Meerleer, Gert
A1  - Bossi, Alberto
A1  - Haustermans, Karin
A1  - Montorsi, Francesco
A1  - Van Poppel, Hendrik
A1  - Spahn, Martin
A1  - Briganti, Alberto
A1  - Joniau, Steven
T1  - Impact of lymph node burden on survival of high-risk prostate cancer patients following radical prostatectomy and pelvic lymph node dissection
JF  - Frontiers in Surgery
N2  - 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.
KW  - high-risk prostate cancer
KW  - lymph node dissection
KW  - positive lymph node
KW  - prognosis
KW  - surgery
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-195721
SN  - 2296-875X
VL  - 3
ER  -