Presentation Authors: Maria Chiara Sighinolfi*, Modena, Italy, Ahmed Eissa, Tanta, Egypt, Marco Sandri, Brescia, Italy, Stefano Puliatti, Maria Giuseppa Vitale, Alessio Bruni, Modena, Italy, Alberto Romano, Capri, Italy, Luca Reggiani Bonetti, Ilaria Bagni, Modena, Italy, Giancarlo Peracchia, Capri, Italy, Riccardo Grisanti, Sassuolo, Italy, Ahmed Zoeir, Tanta, Egypt, Salvatore Micali, Modena, Italy, Vipul Patel, Orlando, FL, Giampaolo Bianchi, Bernardo Maria Rocco, Modena, Italy
Introduction: Lymph node dissection (LND) during radical prostatectomy (RP) for prostate cancer (PCa) aims to provide information for staging and prognosis, while oncological and survival benefits are debatable. The potential harms of LND should be balanced with the benefits on an individual risk assessment. Given that the eligibility to an eLND is based on the prediction of an aggressive nodal disease, we aimed to explore the actual 5- and 10-years cancer specific survival (CSS) benefit of a LND with the removal of more than 11 nodes on patients with adverse pathological findings (APF) at RP.
Methods: From the Pathological Registry of Modena (Italy), data on ORP with LND performed since 2000 were retrospectively assessed. Patients with at least 5- and 10-years follow up were considered (1274 and 581 patients, respectively). APF at RP were recorded as follows: â‰¥pT3a in 27.9% and a GS â‰¥ 7 in 53.0%. Nodal invasion was evident in 6.4%(n=82), and positive surgical margins in 35.4% (n=451). The median node yield was similar among organ confined and locally advanced disease (p=0.798) and among GS= 6 and GSâ‰¥ 7(p=0.392). Consistent with previous Literature, we divided the number of nodes removed according to a cut-off point of 11 [â‰¤10 versus â‰¥11 (More Extended=ME-LND)]: the correlation between 5- and 10-years CSS and a ME-LND is considered as the primary outcome. Since little is known about the effects of an extended procedure in a pN0 population, the impact of ME-LND on CSS of pN0 with APF at RP is the secondary endpoint.
Results: A ME-LND template was not related to 5- and 10-years CSS in the whole series and in the subgroup with nodal disease (p= 0.33). Overall, considering pN0 PCa, a 5-years (SHR 1.5, 95%CI 0.6-3.7; p=0.409) and 10-years (SHR 1.7, 95%CI 0.6-4.6, p=0.324) CSS benefit was not evident with a ME-LND. Concerning the role of a ME-LND in locally advanced pN0 PCa, SHRs for 5- and 10-years CSS are 1.1 and 1.1 and (95%CI: 0.4 â€“ 3.3; p=0.888; 95%CI: 0.3 â€“ 4.0; p=0.884, respectively). When considering GS â‰¥7 without nodal involvement, HRs for 5- and 10-years CSS were 1.2, and 1.3 (95%CI 0.4-3.3; p=0.773; 95%CI 0.4-4.1; p=0.692).
Conclusions: A more extended template for LND failed to demonstrate a CSS benefit on our cohort. Provided that LND oncological advantage is still debated even in cases of nodal involvement, this series outlines the absence of a survival benefit for patients with APF at RP with a final pN0 status. In conclusion, the indication toward a more extended template continues to rely only upon a staging advantage without a clear relation to the long term CSS.