Biochemical impact in prostate cancer with spared pelvic lymph node dissection: Partin nomogram validation
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v82i6.881Keywords:
Biochemical recurrence, lymphadenectomy, prostate cancer, radical prostatectomyAbstract
Introduction: Lymphadenectomy is the method of choice in lymphatic evaluation in patients diagnosed with prostate cancer. The first challenge is to know the probability of involvement with nomograms, Partin, being the most used. According to these nomograms, those patients with node involvement higher than 2% have an indication for lymphadenectomy during prostatectomy for therapeutic and prognostic purposes. Biochemical recurrence is defined as a serum prostate-specific antigen level greater than 0.2 ng / ml confirmed at least 4 weeks after prostatectomy.
Material and methods: We performed an observational retrospective study where the records of 150 consecutive radical prostatectomy cases performed between 2007-2019 were reviewed. A total of 109 patients were included. The probability of lymph node involvement was calculated by Partin nomogram, and all those with more than 2% were selected. They were divided into two groups: with pelvic lymph node dissection (PLND group) or without pelvic lymph node dissection (non-PLND). A Shapiro-Wilks analysis was carried out to check the normality of the data. The p <0.01 in both cases, therefore a Wilcoxon test was carried out, using the Statistical 8.0 program
Results: Using a Spearman correlation and with a p> 0.01, it was found that there was no relationship between the calculation of more than 2% of lymph node involvement by Partin and early biochemical recurrence. We found no significant differences.
Conclusion: In our study, lymphadenectomy did not showed difference in the risk of biochemical progression. Sparing pelvic lymphadenectomy during prostatectomy with a percentage greater than or equal to 2% per Partin nomogram does not have a direct relationship with biochemical recurrence. The use of other nomograms adjusted to our population can make a difference in these results.
References
Khan MA, Partin AW. Management of patients with an increasing prostate-specific antigen after radical prostatectomy. Curr Urol Rep. 2004 May 1;5(3):179–87. doi: https://doi.org/10.1007/s11934-004-0035-5
Partin AW, Kattan MW, Subong ENP, Walsh PC, Wojno KJ, Oesterling JE, et al. Combination of Prostate-Specific Antigen, Clinical Stage, and Gleason Score to Predict Pathological Stage of Localized Prostate Cancer: A Multi-institutional Update. JAMA. 1997 May 14;277(18):1445–51. doi: https://doi.org/10.1001/JAMA.1997.03540420041027
Partin AW, Yoo J, Carter HB, Pearson JD, Chan DW, Epstein JI, et al. The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol. 1993 Jul;150(1):110–4. doi: https://doi.org/10.1016/s0022-5347(17)35410-1
Mukamel E, Hannah J, Barbaric Z, deKernion JB. The value of computerized tomography scan and magnetic resonance imaging in staging prostatic carcinoma: comparison with the clinical and histological staging. J Urol. 1986 Dec;136(6):1231–3. doi: https://doi.org/10.1016/s0022-5347(17)45294-3
Wolf JS, Cher M, Dall’era M, Presti JC, Hricak H, Carroll PR. The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol. 1995 Mar;153(3 Pt 2):993–9. doi: https://doi.org/10.1016/S0022-5347(01)67620-1
Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2013;111(1):22–9. doi: https://doi.org/10.1111/j.1464-410X.2012.11324.x
Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD. Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 2001 Dec 1;58(6):843–8. doi: https://doi.org/10.1016/S0090-4295(01)01441-8
Cagiannos I, Karakiewicz P, Eastham JA, Ohori M, Rabbani F, Gerigk C, et al. A Preoperative Nomogram Identifying Decreased Risk of Positive Pelvic Lymph Nodes in Patients With Prostate Cancer. J Urol. 2003 Nov;170(5):1798–803. doi: https://doi.org/10.1097/01.ju.0000091805.98960.13
Partin AW, Pound CR, Clemens JQ, Epstein JI, Walsh PC. Serum PSA after anatomic radical prostatectomy. The Johns Hopkins experience after 10 years. Urol Clin North Am. 1993 Nov;20(4):713–25.
Gandaglia G, Ploussard G, Valerio M, Mattei A, Fiori C, Fossati N, et al. A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies. Eur Urol. 2019 Mar;75(3):506–14. doi: https://doi.org/10.1016/j.eururo.2018.10.012
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012 Mar;61(3):480–7. doi: https://doi.org/10.1016/j.eururo.2011.10.044
Roach M, Marquez C, Yuo HS, Narayan P, Coleman L, Nseyo UO, et al. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1994 Jan 1;28(1):33–7. doi: https://doi.org/10.1016/0360-3016(94)90138-4
Cimino S, Reale G, Castelli T, Favilla V, Giardina R, Russo GI, et al. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol. 2017 Oct;51(5):345–50. doi: https://doi.org/10.1080/21681805.2017.1332680
Dell’Oglio P, Abdollah F, Suardi N, Gallina A, Cucchiara V, Vizziello D, et al. External validation of the European association of urology recommendations for pelvic lymph node dissection in patients treated with robot-assisted radical prostatectomy. J Endourol. 2014 Apr;28(4):416–23. doi: https://doi.org/10.1089/end.2013.0571
Hinev AI, Anakievski D, Kolev NH, Hadjiev VI. Validation of nomograms predicting lymph node involvement in patients with prostate cancer undergoing extended pelvic lymph node dissection. Urol Int. 2014;92(3):300–5. doi: https://doi.org/10.1159/000354323
Abdollah F, Cozzarini C, Suardi N, Gallina A, Capitanio U, Bianchi M, et al. Indications for pelvic nodal treatment in prostate cancer should change. Validation of the Roach formula in a large extended nodal dissection series. Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):624–9. doi: https://doi.org/10.1016/j.ijrobp.2011.06.2014
Gandaglia G, Fossati N, Zaffuto E, Bandini M, Dell’Oglio P, Bravi CA, et al. Development and Internal Validation of a Novel Model to Identify the Candidates for Extended Pelvic Lymph Node Dissection in Prostate Cancer. Eur Urol. 2017 Oct;72(4):632–40. doi: https://doi.org/10.1016/j.eururo.2017.03.049
Gandaglia G, Martini A, Ploussard G, Fossati N, Stabile A, De Visschere P, et al. External Validation of the 2019 Briganti Nomogram for the Identification of Prostate Cancer Patients Who Should Be Considered for an Extended Pelvic Lymph Node Dissection. Eur Urol. 2020 Aug;78(2):138–42. doi: https://doi.org/10.1016/j.eururo.2020.03.023
Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999 May 5;281(17):1591–7. doi: https://doi.org/10.1001/jama.281.17.1591
Ward JF, Moul JW. Biochemical recurrence after definitive prostate cancer therapy. Part I: defining and localizing biochemical recurrence of prostate cancer. Curr Opin Urol. 2005 May;15(3):181–6. doi: https://doi.org/10.1097/01.mou.0000165552.79416.11
Bhatta-Dhar N, Reuther AM, Zippe C, Klein EA. No difference in six-year biochemical failure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients with localized prostate cancer. Urology. 2004 Mar;63(3):528–31. doi: https://doi.org/10.1016/j.urology.2003.09.064
Aleman M, Karakiewicz PI, Kupelian P, Kattan MW, Graefen M, Cagiannos I, et al. Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/mL: implications for screening. Urology. 2003 Jul;62(1):70–4. doi: https://doi.org/10.1016/s0090-4295(03)00125-0
Bader P, Burkhard FC, Markwalder R, Studer UE. Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol. 2003 Mar;169(3):849–54. doi: https://doi.org/10.1097/01.ju.0000049032.38743.c7
Fergany A, Kupelian PA, Levin HS, Zippe CD, Reddy C, Klein EA. No difference in biochemical failure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients. Urology. 2000 Jul;56(1):92–5. doi: https://doi.org/10.1016/s0090-4295(00)00550-1
Meng MV, Carroll PR. When is pelvic lymph node dissection necessary before radical prostatectomy? A decision analysis. J Urol. 2000 Oct;164(4):1235–40. doi: https://doi.org/10.1016/S0022-5347(05)67147-9
Boorjian SA, Thompson RH, Siddiqui S, Bagniewski S, Bergstralh EJ, Karnes RJ, et al. Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol. 2007 Sep;178(3 Pt 1):864–70; discussion 870-871. doi: https://doi.org/10.1016/j.juro.2007.05.048
Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol. 2002 Apr;167(4):1681–6. doi: https://doi.org/10.1016/S0022-5347(05)65177-4
Campbell SC, Klein EA, Levin HS, Piedmonte MR. Open pelvic lymph node dissection for prostate cancer: a reassessment. Urology. 1995 Sep;46(3):352–5. doi: https://doi.org/10.1016/s0090-4295(99)80219-2
Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006 Jun;7(6):472–9. doi: https://doi.org/10.1016/s1470-2045(06)70700-8
Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med. 1999 Dec 9;341(24):1781–8. doi: https://doi.org/10.1056/nejm199912093412401
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