Presentation Authors: David F. Friedlander*, Brighton, MA, Marieke J Krimphove, Alexander P. Cole, Stuart R. Lipsitz, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA
Introduction: Despite clinical practice guidelines recommending pelvic lymph node dissection (PLND) during radical prostatectomy (RP) for intermediate/high-risk prostate cancer (PCa), controversy exists over both the anatomical extent and survival benefit of PLND during RP. We sought to examine facility-level variation in the extent of PLND during RP for clinically localized/high-risk PCa and to determine if more extensive PLND is associated with a survival benefit.
Methods: Using data from the National Cancer Data Base, we identified 13,652 men â‰¤65 years of age and with a Charlson Comorbidity Index (CCI)=0 receiving care within the United States for biopsy confirmed localized high-risk PCa diagnosed between January 2004 and December 2011. Multilevel, multinomial logistic regression was fitted to predict the odds of receiving different extents of PLND. Inverse propensity weighting (IPTW)-adjusted Cox regression with a Bonferroni correction for multiple endpoint comparisons was fitted to compare risk of overall mortality between the PLND groups.
Results: Overall, 11,284 (82.7%), 1,601 (11.7%), and 767 (5.6%) of men undergoing RP underwent concomitant none/limited PLND, standard PLND (sPLND), and extended PLND (ePLND), respectively. ePLND was not associated with a survival benefit relative to sPLND (HR 0.72, 95% CI 0.48-1.23; p=0.4) nor no/limited PLND (HR 0.77, 95% CI 0.87-2.20; p=0.29) at a median follow-up of 83.3 months. Facility-level predicted probabilities of undergoing ePLND, sPLND, or no/limited PLND ranged from 0.01-52.6%, 3.3-53.3%, and 17.8-96.3%, respectively.
Conclusions: After performing IPTW, we found significant facility-level variation in the extent of PLND during RP despite no apparent survival benefit associated with PLND. Further prospective data is needed to reevaluate what if any role PLND should play in the management of clinically localized PCa treated with RP.
Source of Funding: Quoc-Dien Trinh is supported by the Brigham Research Institute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the Ame