Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: A multi-institution international study

Young Suk Kwon, Yun Sok Ha, Parth K. Modi, Amirali Salmasi, Jaspreet S. Parihar, Neal Patel, Izak Faiena, Michael May, David I. Lee, Elton Llukani, Tuliao Patrick, Koon Ho Rha, Thomas Ahlering, Douglas Skarecky, Hanjong Ahn, Seung Kwon Choi, Sejun Park, Seong Soo Jeon, Yen Chuan Ou, Daniel EunVarsha Manucha, David Albala, Ketan Badani, Bertram Yuh, Nora Ruel, Tae Hwan Kim, Tae Gyun Kwon, Daniel Marchalik, Jonathan Hwang, Wun Jae Kim, Isaac Yi Kim

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

Original languageEnglish
Article number79
JournalBMC Urology
Volume15
Issue number1
DOIs
Publication statusPublished - 2015 Aug 1

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Adipose Tissue
Lymph Nodes
Neoplasm Metastasis
Prostatic Diseases
Prostatectomy
Recurrence
Prostatic Neoplasms
Neoplasm Grading
Chi-Square Distribution
Analysis of Variance

All Science Journal Classification (ASJC) codes

  • Reproductive Medicine
  • Urology

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Kwon, Young Suk ; Ha, Yun Sok ; Modi, Parth K. ; Salmasi, Amirali ; Parihar, Jaspreet S. ; Patel, Neal ; Faiena, Izak ; May, Michael ; Lee, David I. ; Llukani, Elton ; Patrick, Tuliao ; Rha, Koon Ho ; Ahlering, Thomas ; Skarecky, Douglas ; Ahn, Hanjong ; Choi, Seung Kwon ; Park, Sejun ; Jeon, Seong Soo ; Ou, Yen Chuan ; Eun, Daniel ; Manucha, Varsha ; Albala, David ; Badani, Ketan ; Yuh, Bertram ; Ruel, Nora ; Kim, Tae Hwan ; Kwon, Tae Gyun ; Marchalik, Daniel ; Hwang, Jonathan ; Kim, Wun Jae ; Kim, Isaac Yi. / Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes : A multi-institution international study. In: BMC Urology. 2015 ; Vol. 15, No. 1.
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title = "Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: A multi-institution international study",
abstract = "Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 {\%}) were up-staged based on the pathologic analysis of PAFP and eight (9.1 {\%}) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 {\%}) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.",
author = "Kwon, {Young Suk} and Ha, {Yun Sok} and Modi, {Parth K.} and Amirali Salmasi and Parihar, {Jaspreet S.} and Neal Patel and Izak Faiena and Michael May and Lee, {David I.} and Elton Llukani and Tuliao Patrick and Rha, {Koon Ho} and Thomas Ahlering and Douglas Skarecky and Hanjong Ahn and Choi, {Seung Kwon} and Sejun Park and Jeon, {Seong Soo} and Ou, {Yen Chuan} and Daniel Eun and Varsha Manucha and David Albala and Ketan Badani and Bertram Yuh and Nora Ruel and Kim, {Tae Hwan} and Kwon, {Tae Gyun} and Daniel Marchalik and Jonathan Hwang and Kim, {Wun Jae} and Kim, {Isaac Yi}",
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doi = "10.1186/s12894-015-0070-1",
language = "English",
volume = "15",
journal = "BMC Urology",
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Kwon, YS, Ha, YS, Modi, PK, Salmasi, A, Parihar, JS, Patel, N, Faiena, I, May, M, Lee, DI, Llukani, E, Patrick, T, Rha, KH, Ahlering, T, Skarecky, D, Ahn, H, Choi, SK, Park, S, Jeon, SS, Ou, YC, Eun, D, Manucha, V, Albala, D, Badani, K, Yuh, B, Ruel, N, Kim, TH, Kwon, TG, Marchalik, D, Hwang, J, Kim, WJ & Kim, IY 2015, 'Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: A multi-institution international study', BMC Urology, vol. 15, no. 1, 79. https://doi.org/10.1186/s12894-015-0070-1

Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes : A multi-institution international study. / Kwon, Young Suk; Ha, Yun Sok; Modi, Parth K.; Salmasi, Amirali; Parihar, Jaspreet S.; Patel, Neal; Faiena, Izak; May, Michael; Lee, David I.; Llukani, Elton; Patrick, Tuliao; Rha, Koon Ho; Ahlering, Thomas; Skarecky, Douglas; Ahn, Hanjong; Choi, Seung Kwon; Park, Sejun; Jeon, Seong Soo; Ou, Yen Chuan; Eun, Daniel; Manucha, Varsha; Albala, David; Badani, Ketan; Yuh, Bertram; Ruel, Nora; Kim, Tae Hwan; Kwon, Tae Gyun; Marchalik, Daniel; Hwang, Jonathan; Kim, Wun Jae; Kim, Isaac Yi.

In: BMC Urology, Vol. 15, No. 1, 79, 01.08.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes

T2 - A multi-institution international study

AU - Kwon, Young Suk

AU - Ha, Yun Sok

AU - Modi, Parth K.

AU - Salmasi, Amirali

AU - Parihar, Jaspreet S.

AU - Patel, Neal

AU - Faiena, Izak

AU - May, Michael

AU - Lee, David I.

AU - Llukani, Elton

AU - Patrick, Tuliao

AU - Rha, Koon Ho

AU - Ahlering, Thomas

AU - Skarecky, Douglas

AU - Ahn, Hanjong

AU - Choi, Seung Kwon

AU - Park, Sejun

AU - Jeon, Seong Soo

AU - Ou, Yen Chuan

AU - Eun, Daniel

AU - Manucha, Varsha

AU - Albala, David

AU - Badani, Ketan

AU - Yuh, Bertram

AU - Ruel, Nora

AU - Kim, Tae Hwan

AU - Kwon, Tae Gyun

AU - Marchalik, Daniel

AU - Hwang, Jonathan

AU - Kim, Wun Jae

AU - Kim, Isaac Yi

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

AB - Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

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DO - 10.1186/s12894-015-0070-1

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