Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Not as Good as Previously Thought.

Autor: Bravi CA; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Fossati N; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Gandaglia G; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Suardi N; Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy., Mazzone E; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Robesti D; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Osmonov D; Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany., Juenemann KP; Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany., Boeri L; Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, IRCCS Foundation Ca Granda, Maggiore Policlinico Hospital, University of Milan, Milan, Italy., Jeffrey Karnes R; Department of Urology, Mayo Clinic, Rochester, MN, USA., Kretschmer A; Department of Urology, Ludwig-Maximilians University, Munich, Germany., Buchner A; Department of Urology, Ludwig-Maximilians University, Munich, Germany., Stief C; Department of Urology, Ludwig-Maximilians University, Munich, Germany., Hiester A; Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany., Nini A; Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Urology and Pediatric Urology, Saarland University Medical Center, Saarland University, Homburg, Germany., Albers P; Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany., Devos G; Department of Urology, University Hospitals Leuven, Leuven, Belgium., Joniau S; Department of Urology, University Hospitals Leuven, Leuven, Belgium., Van Poppel H; Department of Urology, University Hospitals Leuven, Leuven, Belgium., Shariat SF; Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Heidenreich A; Department of Urology, University of Cologne, Cologne, Germany., Pfister D; Department of Urology, University of Cologne, Cologne, Germany., Tilki D; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Graefen M; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Gill IS; USC Institute of Urology, University of Southern California, Los Angeles, CA, USA., Mottrie A; Department of Urology, OLV Ziekenhuis Aalst, Melle, Belgium., Karakiewicz PI; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada., Montorsi F; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Briganti A; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: briganti.alberto@hsr.it.
Jazyk: angličtina
Zdroj: European urology [Eur Urol] 2020 Nov; Vol. 78 (5), pp. 661-669. Date of Electronic Publication: 2020 Jul 02.
DOI: 10.1016/j.eururo.2020.06.043
Abstrakt: Background: Long-term outcomes of patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer (PCa) remain unknown.
Objective: To investigate long-term oncological outcomes after sLND in a large multi-institutional series.
Design, Setting, and Participants: The study included 189 patients who experienced prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy (RP) and underwent sLND at 11 tertiary referral centers between 2002 and 2011. Lymph node recurrence was documented by positron emission tomography/computed tomography (PET/CT) scan using either 11 C-choline or 68 Ga prostate-specific membrane antigen ligand.
Outcome Measurements and Statistical Analysis: The primary outcome of the study was cancer-specific mortality (CSM). The secondary outcomes were overall mortality, clinical recurrence (CR), biochemical recurrence (BCR), and androgen deprivation therapy (ADT)-free survival after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. Cox regression analysis was used to predict the risk of prostate CSM after accounting for several parameters, including the use of additional treatments after sLND.
Results and Limitations: At long term, 110 and 163 patients experienced CR and BCR, respectively, with CR-free and BCR-free survival at 10 yr of 31% and 11%, respectively. After sLND, a total of 145 patients received ADT, with a median time to ADT of 41 mo. At a median (interquartile range) follow-up for survivors of 87 (51, 104) mo, 48 patients died. Of them, 45 died from PCa. The probabilities of freedom from cancer-specific and all-cause death at 10 yr were 66% and 64%, respectively. Similar results were obtained in sensitivity analyses in patients with pelvic-only positive PET/CT scan, as well as after excluding men on ADT at PET/CT scan and patients with PSA level at sLND higher than the 75th percentile. At multivariable analyses, patients who had PSA response after sLND (hazard ratio [HR]: 0.45; p = 0.001), and those receiving ADT within 6 mo from sLND (HR: 0.51; p = 0.010) had lower risk of death from PCa.
Conclusions: A third of men treated with sLND for PET-detected nodal recurrence of PCa died at long term, with PCa being the main cause of death. Salvage LND alone was associated with durable long-term outcomes in a minority of men who significantly benefited from additional treatments after surgery. Taken together, all these data argue against the use of metastasis-directed therapy alone for patients with node-only recurrent PCa. These men should instead be considered at high risk of systemic dissemination already at the time of sLND.
Patient Summary: We assessed long-term outcomes of patients treated with salvage lymph node dissection (sLND) for node-recurrent prostate cancer (PCa). In contrast with prior evidence, we found that the majority of these men recurred after sLND and eventually died from PCa. A significant survival benefit associated with the administration of androgen deprivation therapy after sLND suggests that sLND should be considered part of a multimodal approach rather than an exclusive treatment strategy.
(Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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