Single positive lymph node prostate cancer can be treated surgically without recurrence

Dae Keun Kim, Kyo Chul Koo, Ali Abdel Raheem, Ki Hong Kim, Byung Ha Chung, Young Deuk Choi, Koon Ho Rha

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose/Objectives: To investigate pN1 prostate cancer (PCa) patients treated surgically without immediate adjuvant treatment. Materials and Methods: We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP)/radical prostatectomy (RP) between July 2005 and November 2012. 87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer specific survival (CSS), and overall survival (OS) rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA) level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks), PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival. Results: The 5-year OS rate of patients was 86.1%, while the CSS rate was 89.6%. The metastasis-free and BCR-free survival rates were 71% and 19.1%, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively). The presence of 2 or more pathologically positive LNs (HR:2.20; 95% CI 1.30-3.72; p = 0.003) and a Gleason score ≥8 (HR: 2.40;95% CI: 1.32-4.38; p = 0.04) were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95% CI 1.01-1.11; p = 0.029) were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90%) had single positive LN and 5 patients out of 10 (50%) had Gleason score 7. Therefore, single positive LN, and Gleason scores ≤7 have significantly low risk of disease progression. Conclusions: pN1 PCa patients have heterogenous clinical courses. Patients with single positive LN, and Gleason scores ≤7 have low risk of recurrence. Close observation with delayed adjuvant hormone therapy can be considered in these patients.

Original languageEnglish
Article numbere0152391
JournalPloS one
Volume11
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1

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prostatic neoplasms
Prostate-Specific Antigen
Regression analysis
lymph nodes
Prostatic Neoplasms
Lymph Nodes
Recurrence
Neoplasm Grading
prostate-specific antigen
adjuvants
Survival
Tumors
Survival Rate
survival rate
metastasis
Hormones
Robots
regression analysis
Regression Analysis
Prostatectomy

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Kim, Dae Keun ; Koo, Kyo Chul ; Raheem, Ali Abdel ; Kim, Ki Hong ; Chung, Byung Ha ; Choi, Young Deuk ; Rha, Koon Ho. / Single positive lymph node prostate cancer can be treated surgically without recurrence. In: PloS one. 2016 ; Vol. 11, No. 3.
@article{ff45fbb4c3f5439892f3e8fe17d16658,
title = "Single positive lymph node prostate cancer can be treated surgically without recurrence",
abstract = "Purpose/Objectives: To investigate pN1 prostate cancer (PCa) patients treated surgically without immediate adjuvant treatment. Materials and Methods: We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP)/radical prostatectomy (RP) between July 2005 and November 2012. 87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer specific survival (CSS), and overall survival (OS) rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA) level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks), PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival. Results: The 5-year OS rate of patients was 86.1{\%}, while the CSS rate was 89.6{\%}. The metastasis-free and BCR-free survival rates were 71{\%} and 19.1{\%}, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively). The presence of 2 or more pathologically positive LNs (HR:2.20; 95{\%} CI 1.30-3.72; p = 0.003) and a Gleason score ≥8 (HR: 2.40;95{\%} CI: 1.32-4.38; p = 0.04) were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95{\%} CI 1.01-1.11; p = 0.029) were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90{\%}) had single positive LN and 5 patients out of 10 (50{\%}) had Gleason score 7. Therefore, single positive LN, and Gleason scores ≤7 have significantly low risk of disease progression. Conclusions: pN1 PCa patients have heterogenous clinical courses. Patients with single positive LN, and Gleason scores ≤7 have low risk of recurrence. Close observation with delayed adjuvant hormone therapy can be considered in these patients.",
author = "Kim, {Dae Keun} and Koo, {Kyo Chul} and Raheem, {Ali Abdel} and Kim, {Ki Hong} and Chung, {Byung Ha} and Choi, {Young Deuk} and Rha, {Koon Ho}",
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Single positive lymph node prostate cancer can be treated surgically without recurrence. / Kim, Dae Keun; Koo, Kyo Chul; Raheem, Ali Abdel; Kim, Ki Hong; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho.

In: PloS one, Vol. 11, No. 3, e0152391, 01.03.2016.

Research output: Contribution to journalArticle

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T1 - Single positive lymph node prostate cancer can be treated surgically without recurrence

AU - Kim, Dae Keun

AU - Koo, Kyo Chul

AU - Raheem, Ali Abdel

AU - Kim, Ki Hong

AU - Chung, Byung Ha

AU - Choi, Young Deuk

AU - Rha, Koon Ho

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Y1 - 2016/3/1

N2 - Purpose/Objectives: To investigate pN1 prostate cancer (PCa) patients treated surgically without immediate adjuvant treatment. Materials and Methods: We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP)/radical prostatectomy (RP) between July 2005 and November 2012. 87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer specific survival (CSS), and overall survival (OS) rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA) level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks), PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival. Results: The 5-year OS rate of patients was 86.1%, while the CSS rate was 89.6%. The metastasis-free and BCR-free survival rates were 71% and 19.1%, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively). The presence of 2 or more pathologically positive LNs (HR:2.20; 95% CI 1.30-3.72; p = 0.003) and a Gleason score ≥8 (HR: 2.40;95% CI: 1.32-4.38; p = 0.04) were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95% CI 1.01-1.11; p = 0.029) were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90%) had single positive LN and 5 patients out of 10 (50%) had Gleason score 7. Therefore, single positive LN, and Gleason scores ≤7 have significantly low risk of disease progression. Conclusions: pN1 PCa patients have heterogenous clinical courses. Patients with single positive LN, and Gleason scores ≤7 have low risk of recurrence. Close observation with delayed adjuvant hormone therapy can be considered in these patients.

AB - Purpose/Objectives: To investigate pN1 prostate cancer (PCa) patients treated surgically without immediate adjuvant treatment. Materials and Methods: We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP)/radical prostatectomy (RP) between July 2005 and November 2012. 87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer specific survival (CSS), and overall survival (OS) rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA) level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks), PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival. Results: The 5-year OS rate of patients was 86.1%, while the CSS rate was 89.6%. The metastasis-free and BCR-free survival rates were 71% and 19.1%, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively). The presence of 2 or more pathologically positive LNs (HR:2.20; 95% CI 1.30-3.72; p = 0.003) and a Gleason score ≥8 (HR: 2.40;95% CI: 1.32-4.38; p = 0.04) were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95% CI 1.01-1.11; p = 0.029) were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90%) had single positive LN and 5 patients out of 10 (50%) had Gleason score 7. Therefore, single positive LN, and Gleason scores ≤7 have significantly low risk of disease progression. Conclusions: pN1 PCa patients have heterogenous clinical courses. Patients with single positive LN, and Gleason scores ≤7 have low risk of recurrence. Close observation with delayed adjuvant hormone therapy can be considered in these patients.

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