Resultados oncológicos en enfermedad N1 posterior a la prostatectomía radical

Background

Radical prostatectomy + pelvic lymph node dissection can improve progression-free survival and cancer-specific survival in lymph node disease.

Aim

To analyze the characteristics of patients with lymph node disease in the histopathologic findings of the radical prostatectomy and lymph node dissection.

Material and methods

A retrospective study was carried out on patients that underwent radical prostatectomy with metastatic lymph node disease within the time frame of 1988 to 2015.

Results

The study included 25 patients with a mean 66.5 years of age (SD ± 6.5), a mean prostate-specific antigen of 20.17 ng/dl (IQR: 18), and a median follow-up period of 63 months (IQR: 86). According to the D’Amico classification, 15 (60%) patients were high-risk, 8 (32%) were intermediate-risk, and 2 (8%) were low-risk. Positive margins were found in 15 cases (60%); 4 (16%) patients had T2 tumor stage, 3 (12%) had T3A, 17 (68%) had T3B, and one patient (4%) had T4. Fourteen (56%) patients had one positive lymph node, 3 (12%) patients had 2 positive lymph nodes, and 8 (32%) patients had more than 2 positive lymph nodes. Three (16%) patients received radiotherapy and 24 (96%) underwent hormone blockade. Progression-free survival was 105 months and cancer-specific survival was 86% at 5 years and 45% at ten years. The HR for biochemical progression was significant in positive margins (HR: 9.5, 95% CI: 0.99-91.5, P = .50) and when there were ≥ 2 positive lymph nodes (HR: 8.5, 95% CI: 1.1-61.9, P = 0.34). Involvement of ≥ 2 lymph nodes predicted progression with an odds ratio of 7.2 (95% CI: 1.06-48.6, P = .043).

Conclusions

The average 5-year survival was above 80%. The number of positive lymph nodes could be a predictive factor for biochemical progression.