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 - TY - JOUR A1 - D'Andrea, David A1 - Soria, Francesco A1 - Grotenhuis, Anne J. A1 - Cha, Eugene K. A1 - Malats, Nuria A1 - Di Stasi, Savino A1 - Joniau, Steven A1 - Cai, Tommaso A1 - Rhijn, Bas W. G. van A1 - Irani, Jaques A1 - Karnes, Jeffrey A1 - Varkarakis, John A1 - Baniel, Jack A1 - Palou, Joan A1 - Babjuk, Marek A1 - Spahn, Martin A1 - Ardelt, Peter A1 - Colombo, Renzo A1 - Serretta, Vincenzo A1 - Dalbagni, Guido A1 - Gontero, Paolo A1 - Bartoletti, Riccardo A1 - Larré, Stephane A1 - Malmstrom, Per-Uno A1 - Sylvester, Richard A1 - Shariat, Shahrokh F. T1 - Association of patients’ sex with treatment outcomes after intravesical bacillus Calmette–Guérin immunotherapy for T1G3/HG bladder cancer JF - World Journal of Urology N2 - Purpose To investigate the association of patients’ sex with recurrence and disease progression in patients treated with intravesical bacillus Calmette–Guérin (BCG) for T1G3/HG urinary bladder cancer (UBC). Materials and methods We analyzed the data of 2635 patients treated with adjuvant intravesical BCG for T1 UBC between 1984 and 2019. We accounted for missing data using multiple imputations and adjusted for covariate imbalance between males and females using inverse probability weighting (IPW). Crude and IPW-adjusted Cox regression analyses were used to estimate the hazard ratios (HR) with their 95% confidence intervals (CI) for the association of patients’ sex with HG-recurrence and disease progression. Results A total of 2170 (82%) males and 465 (18%) females were available for analysis. Overall, 1090 (50%) males and 244 (52%) females experienced recurrence, and 391 (18%) males and 104 (22%) females experienced disease progression. On IPW-adjusted Cox regression analyses, female sex was associated with disease progression (HR 1.25, 95%CI 1.01–1.56, p = 0.04) but not with recurrence (HR 1.06, 95%CI 0.92–1.22, p = 0.41). A total of 1056 patients were treated with adequate BCG. In these patients, on IPW-adjusted Cox regression analyses, patients’ sex was not associated with recurrence (HR 0.99, 95%CI 0.80–1.24, p = 0.96), HG-recurrence (HR 1.00, 95%CI 0.78–1.29, p = 0.99) or disease progression (HR 1.12, 95%CI 0.78–1.60, p = 0.55). Conclusion Our analysis generates the hypothesis of a differential response to BCG between males and females if not adequately treated. Further studies should focus on sex-based differences in innate and adaptive immune system and their association with BCG response. KW - bladder cancer KW - BCG KW - response KW - age KW - progression KW - recurrence Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-344486 VL - 39 IS - 9 ER -