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Heidenreich A, Pfister D. Pelvic Lymphadenectomy in Clinically Localised Prostate Cancer: Counting Lymph Nodes or Dissecting Primary Landing Zones of the Prostate? Eur Urol 2014; 66:447-9. [DOI: 10.1016/j.eururo.2013.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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52
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Kluth LA, Abdollah F, Xylinas E, Rieken M, Fajkovic H, Sun M, Karakiewicz PI, Seitz C, Schramek P, Herman MP, Becker A, Loidl W, Pummer K, Nonis A, Lee RK, Lotan Y, Scherr DS, Seiler D, Chun FKH, Graefen M, Tewari A, Gönen M, Montorsi F, Shariat SF, Briganti A. Pathologic Nodal Staging Scores in Patients Treated with Radical Prostatectomy: A Postoperative Decision Tool. Eur Urol 2014; 66:439-46. [DOI: 10.1016/j.eururo.2013.06.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/21/2013] [Indexed: 12/31/2022]
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Spahn M. Is It Time To Change the Treatment Paradigm for Lymph Node–Positive Prostate Cancer? Eur Urol 2014; 66:200-1. [DOI: 10.1016/j.eururo.2013.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/21/2013] [Indexed: 11/26/2022]
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Liss MA, Farshchi-Heydari S, Qin Z, Hickey SA, Hall DJ, Kane CJ, Vera DR. Preclinical evaluation of robotic-assisted sentinel lymph node fluorescence imaging. J Nucl Med 2014; 55:1552-6. [PMID: 25024425 DOI: 10.2967/jnumed.114.140871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED An ideal substance to provide convenient and accurate targeting for sentinel lymph node (SLN) mapping during robotic-assisted surgery has yet to be found. We used an animal model to determine the ability of the FireFly camera system to detect fluorescent SLNs after administration of a dual-labeled molecular imaging agent. METHODS We injected the footpads of New Zealand White rabbits with 1.7 or 8.4 nmol of tilmanocept labeled with (99m)Tc and a near-infrared fluorophore, IRDye800CW. One and 36 h after injection, popliteal lymph nodes, representing the SLNs, were dissected with the assistance of the FireFly camera system, a fluorescence-capable endoscopic imaging system. After excision of the paraaortic lymph nodes, which represented non-SLNs, we assayed all lymph nodes for radioactivity and fluorescence intensity. RESULTS Fluorescence within all popliteal lymph nodes was easily detected by the FireFly camera system. Fluorescence within the lymph channel could be imaged during the 1-h studies. When compared with the paraaortic lymph nodes, the popliteal lymph nodes retain greater than 95% of the radioactivity at both 1 and 36 h after injection. At both doses (1.7 and 8.4 nmol), the popliteal nodes had higher (P < 0.050) optical fluorescence intensity than the paraaortic nodes at the 1- and 36-h time points. CONCLUSION The FireFly camera system can easily detect tilmanocept labeled with a near-infrared fluorophore at least 36 h after administration. This ability will permit image acquisition and subsequent verification of fluorescence-labeled SLNs during robotic-assisted surgery.
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Affiliation(s)
- Michael A Liss
- Department of Urology, University of California, San Diego, La Jolla, California UCSD Moores Cancer Center. University of California, San Diego, La Jolla, California
| | - Salman Farshchi-Heydari
- Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California
| | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, California; and
| | - Sean A Hickey
- Department of Surgery, University of California, San Diego, La Jolla, California
| | - David J Hall
- Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California
| | - Christopher J Kane
- Department of Urology, University of California, San Diego, La Jolla, California UCSD Moores Cancer Center. University of California, San Diego, La Jolla, California Department of Surgery, University of California, San Diego, La Jolla, California
| | - David R Vera
- UCSD Moores Cancer Center. University of California, San Diego, La Jolla, California Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California Department of Surgery, University of California, San Diego, La Jolla, California
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Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment. Br J Cancer 2014; 111:213-9. [PMID: 25003663 PMCID: PMC4102948 DOI: 10.1038/bjc.2014.311] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status. METHODS We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes. RESULTS In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively. CONCLUSIONS Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.
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Perry-Keene J, Ferguson P, Samaratunga H, Nacey JN, Delahunt B. Effective maybe, but is it cost-effective? A reply. Histopathology 2014; 65:729-30. [PMID: 24750194 DOI: 10.1111/his.12438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joanna Perry-Keene
- Aquesta Uropathology, Brisbane, Qld, Australia; Royal Brisbane Hospital, Brisbane, Qld, Australia
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Chang AJ, Autio KA, Roach M, Scher HI. High-risk prostate cancer-classification and therapy. Nat Rev Clin Oncol 2014; 11:308-23. [PMID: 24840073 DOI: 10.1038/nrclinonc.2014.68] [Citation(s) in RCA: 296] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Approximately 15% of patients with prostate cancer are diagnosed with high-risk disease. However, the current definitions of high-risk prostate cancer include a heterogeneous group of patients with a range of prognoses. Some have the potential to progress to a lethal phenotype that can be fatal, while others can be cured with treatment of the primary tumour alone. The optimal management of this patient subgroup is evolving. A refined classification scheme is needed to enable the early and accurate identification of high-risk disease so that more-effective treatment paradigms can be developed. We discuss several principles established from clinical trials, and highlight other questions that remain unanswered. This Review critically evaluates the existing literature focused on defining the high-risk population, the management of patients with high-risk prostate cancer, and future directions to optimize care.
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Affiliation(s)
- Albert J Chang
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, CA 94115, USA
| | - Karen A Autio
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA
| | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, CA 94115, USA
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA
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Bi L, Huang H, Fan X, Li K, Xu K, Jiang C, Liu H, Dong W, Zhang S, Yang X, Lin T, Huang J. Extended vs non-extended pelvic lymph node dissection and their influence on recurrence-free survival in patients undergoing radical cystectomy for bladder cancer: a systematic review and meta-analysis of comparative studies. BJU Int 2014; 113:E39-48. [DOI: 10.1111/bju.12371] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Liangkuan Bi
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
- Key Laboratory of Malignant Tumour Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Sun Yat-sen University; Guangzhou China
| | - Hai Huang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Xinxiang Fan
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Kaiwen Li
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Kewei Xu
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Chun Jiang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Hao Liu
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Wen Dong
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Simin Zhang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Xiangyun Yang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Tianxin Lin
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
- Key Laboratory of Malignant Tumour Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Sun Yat-sen University; Guangzhou China
| | - Jian Huang
- Department of Urology; Sun Yat-sen Memorial Hospital, Sun Yat-sen University
- Key Laboratory of Malignant Tumour Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Sun Yat-sen University; Guangzhou China
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Demir A, Karadağ MA, Türkeri L. Is there a relationship between the number of lymph nodes and disease parameters in patients who underwent retropubic prostatectomy. Int Urol Nephrol 2014; 46:1537-41. [PMID: 24664551 DOI: 10.1007/s11255-014-0692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We aimed to establish the relationship between lymph nodes (LNs) counts that were removed with standard pelvic lymph node dissection (sPLND) and different disease parameters in patients who underwent radical prostatectomy (RP). MATERIALS AND METHODS A total of 70 patients who underwent sPLND during RP were scanned retrospectively. The scanned parameters were levels of serum PSA, the total weight of the removed prostate, the amount as a percentage of the tumor in the prostate tissue, the stage of the tumor, the total Gleason score (GS) and the number of standard pelvic lymph nodes that were removed from both right and left sides. RESULTS The average age of the patients was 59 years. A positive correlation was found between the total GS and the number of lymph nodes; while this correlation was significant (p = 0.0038), there was no significant difference between lymph nodes counts and other scanned parameters. The average pelvic lymph node numbers of patients with GS of 6-7 and 8 were 10.4-11.5 and 13.2, respectively. Lymph nodes metastases were found in 3 (4.2 %) patients whose average pelvic lymph node number was 17.3. CONCLUSION The chance of cure or decreased recurrence is much more possible in patients who had received extended PLND or at least standard one, because of the removal of much more lymph node tissues that have a high probability of disseminating cancer cells. This position can especially be considered in patients with high GS.
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Affiliation(s)
- Aslan Demir
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey,
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Zehnder P, Studer UE, Daneshmand S, Birkhäuser FD, Skinner EC, Roth B, Miranda G, Burkhard FC, Cai J, Skinner DG, Thalmann GN, Gill IS. Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy. BJU Int 2014; 113:554-60. [PMID: 24131453 DOI: 10.1111/bju.12520] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the long-term outcomes of patients with lymph node (LN)-positive bladder cancer, who did not receive any adjuvant therapy after radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND). PATIENTS AND METHODS We conducted a retrospective, combined cohort analysis based on two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern. Eligible patients underwent RC with ePLND for cN0M0 disease but were found to have LN-positive disease. No patient had neoadjuvant therapy, and all had negative surgical margins. Kaplan-Meier plots were used to estimate recurrence-free survival (RFS) and overall survival (OS). Subgroup comparisons were performed using log-rank tests, and multivariable analysis was based on Cox proportional hazard models. RESULTS Of 521 patients with LN-positive disease, 251 (48%) never received adjuvant therapy. Although the pathological stage distribution was similar, the 251 patients who did not receive adjuvant therapy were older and had both fewer total and positive LNs than those who underwent adjuvant therapy. The median RFS for patients treated with RC alone was 1.6 years. Recurrences mainly occurred <2 years after RC, resulting in 5- and 10-year RFS rates of 32 and 26%, respectively. Pathological T stage, the total number of LNs and the number of positive LNs detected were independent predictors of RFS and OS. CONCLUSIONS In this study, 25% of patients with documented LN metastases who did not receive adjuvant therapy were cured with RC and ePLND; however, a few relapses may occur later than 3 years. Predictors of survival were pathological T stage, the number of total LNs and the number of positive LNs identified.
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Affiliation(s)
- Pascal Zehnder
- USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Urology, University of Bern, Bern, Switzerland
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Heck MM, Souvatzoglou M, Retz M, Nawroth R, Kübler H, Maurer T, Thalgott M, Gramer BM, Weirich G, Rondak IC, Rummeny EJ, Schwaiger M, Gschwend JE, Krause B, Eiber M. Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients. Eur J Nucl Med Mol Imaging 2013; 41:694-701. [PMID: 24297503 DOI: 10.1007/s00259-013-2634-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/06/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to prospectively compare diffusion-weighted magnetic resonance imaging (DWI) and [(11)C]choline positron emission tomography/computed tomography (PET/CT) with computed tomography (CT) for preoperative lymph node (LN) staging in prostate cancer (PCa) patients. METHODS Between June 2010 and May 2012, CT, DWI and [(11)C]choline PET/CT were performed preoperatively in 33 intermediate- and high-risk PCa patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) including obturator fossa and internal, external and common iliac fields. Patient- and field-based performance characteristics for all three imaging techniques based on histopathological results are reported. Imaging techniques were compared by means of the area under the curve (AUC). RESULTS LN metastases were detected in 92 of 1,012 (9%) LNs from 14 of 33 (42%) patients. On patient-based analysis, sensitivity, specificity and accuracy for CT were 57, 68 and 64%, respectively, for DWI were 57, 79 and 70%, respectively, and for [(11)C]choline PET/CT were 57, 90 and 76%, respectively. On field-based analysis, these numbers for CT were 47, 94 and 88%, respectively, for DWI were 56, 97 and 92%, respectively, and for [(11)C]choline PET/CT were 62, 96 and 92%, respectively. Neither DWI nor [(11)C]choline PET/CT performed significantly better than CT on pairwise comparison of patient- and field-based results. CONCLUSION All three imaging techniques exhibit a rather low sensitivity with less than two thirds of LN metastases being detected on patient- and field-based analysis. Overall diagnostic efficacy did not differ significantly between imaging techniques, whereas distinct performance characteristics, esp. patient-based specificity, were best for [(11)C]choline PET/CT followed by DWI and CT.
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Affiliation(s)
- Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
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Detection of pelvic lymph node micrometastasis by real-time reverse transcriptase polymerase chain reaction in prostate cancer patients after hormonal therapy. J Cancer Res Clin Oncol 2013; 140:235-41. [PMID: 24292502 DOI: 10.1007/s00432-013-1558-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the feasibility of prostatic-specific antigen (PSA) mRNA and prostatic-specific membrane antigen (PSMA) mRNA measurement in detection of pelvic lymph node (PLN) micrometastasis for prostate cancer (PCa) after hormonal therapy (HT). METHODS Fifty-four patients diagnosed as high risk localized PCa were given HT for 3 months before radical prostatectomy. Under bipedal lymphangiography, a needle was punctured into involved lymph nodes (LN) and aspirated lymphatic fluid was obtained preoperatively. The expression of PSA mRNA and PSMA mRNA in aspirated fluid was assessed by a fully quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) and also in LN specimens from pelvic lymphadenectomy during prostatectomy. RESULTS Median follow-up was 36 months (range 18-58 months). Without histological evidence of PLN metastasis, twelve patients showed positive PSA and/or PSMA mRNA expressions and regarded as having micrometastases to PLNs. Biochemical recurrence (BCR) rate and interval between prostatectomy and BCR in patients with micrometastases (group B) were not significantly different to histologically proven PLN metastatic patients (group A) (58.3 vs. 83.3 %, P = 0.26; 10.9 vs. 9.2 months, P = 0.29, respectively), but significantly different to those with no PLN involvement (group C) (58.3 vs. 11.1 %, P = 0.002; 10.9 vs. 21.3 months, P < 0.001, respectively). Kaplan-Meier analysis showed both groups A and B had significantly lower non-BCR rate than group C (P < 0.001, P < 0.001, respectively). CONCLUSIONS For PCa patients receiving HT, measurement of PSA mRNA and PSMA mRNA in aspirated PLN fluid by real-time RT-PCR could effectively detect PLN micrometastases without surgical intervention.
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64
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Pedrosa JA, Koch MO, Cheng L. Lymph node-positive bladder cancer: surgical, pathologic, molecular and prognostic aspects. Expert Rev Anticancer Ther 2013; 13:1281-95. [PMID: 24134387 DOI: 10.1586/14737140.2013.850847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The presence of lymphatic metastasis is associated with markedly worse prognosis in patients with bladder cancer, although surgical resection and chemotherapy can still provide long-term survival for selected patients. The prognostic stratification of patients with positive lymph nodes has been broadly discussed in the current literature and a more extensive pelvic lymph node dissection and thorough pathologic assessment has been advocated. It is clear that stratification using the tumor node metastasis staging system is insufficient to adequately discriminate prognosis between patients with different lymph node involvement. Lymph node density and extranodal extension have been extensively investigated and appear to influence the prognosis of these patients. Molecular markers have been developed to improve the diagnosis of micrometastatic disease, and new targeted therapies have shown promising preclinical results and are now being tested in different clinical scenarios.
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Affiliation(s)
- Jose A Pedrosa
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Perry-Keene J, Ferguson P, Samaratunga H, Nacey JN, Delahunt B. Total submission of pelvic lymphadenectomy tissues removed during radical prostatectomy for prostate cancer increases lymph node yield and detection of micrometastases. Histopathology 2013; 64:399-404. [DOI: 10.1111/his.12262] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Joanna Perry-Keene
- Aquesta Pathology; Brisbane QLD Australia
- Royal Brisbane Hospital; Brisbane QLD Australia
| | - Peter Ferguson
- Malaghan Institute of Medical Research; Wellington New Zealand
- Department of Pathology and Molecular Medicine; Wellington School of Medicine and Health Sciences; University of Otago; Wellington New Zealand
| | | | - John N Nacey
- Department of Surgery; Wellington School of Medicine and Health Sciences; University of Otago; Wellington New Zealand
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine; Wellington School of Medicine and Health Sciences; University of Otago; Wellington New Zealand
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Kluth LA, Xylinas E, Rieken M, Chun FKH, Fajkovic H, Becker A, Karakiewicz PI, Passoni N, Herman M, Lotan Y, Seitz C, Schramek P, Remzi M, Loidl W, Guillonneau B, Rouprêt M, Briganti A, Scherr DS, Graefen M, Tewari AK, Shariat SF. Does increasing the nodal yield improve outcomes in contemporary patients without nodal metastasis undergoing radical prostatectomy? Urol Oncol 2013; 32:47.e1-8. [PMID: 24055425 DOI: 10.1016/j.urolonc.2013.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/22/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if the number of lymph nodes (LNs) removed is an independent predictor of biochemical recurrence (BCR) in patients without LN metastases undergoing radical prostatectomy (RP). MATERIAL AND METHODS Retrospective analysis of 7,310 patients treated at 7 centers with RP and pelvic LN dissection for clinically localized prostate cancer between 2000 and 2011. Patients with LN metastases (n = 398) and other reasons (stated later in the article) (n = 372) were excluded, which left 6,540 patients for the final analyses. RESULTS Overall, median biopsy and RP Gleason score were both 7; median prostate specific antigen level was 6 ng/ml (interquartile range [IQR]: 5); and median number of LNs removed was 6 (IQR: 8). A total of 3,698 (57%), 2,064 (32%), and 508 (8%) patients had ≥ 6, ≥ 10, and ≥ 20 LNs removed, respectively. Patients with more LNs removed were older, had a higher prostate specific antigen level, had higher clinical and pathologic T stage, and had higher RP Gleason score (all P<0.002). Within a median follow-up of 21 (IQR: 16) months, more LNs removed was associated with an increased risk of BCR (continuous: P = 0.021; categorical: P = 0.014). In multivariable analyses that adjusted for the effects of standard clinicopathologic factors, none of the nodal stratifications predicted BCR. CONCLUSIONS The number of LNs did not have any prognostic significance in our contemporary cohort of patients with LN-negative prostate cancer. This suggests that the risk of missed clinically significant micrometastasis may be minimal in patients currently treated with RP and having a lower LN yield.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Malte Rieken
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Hospital of Basel, Basel, Switzerland
| | - Felix K-H Chun
- Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harun Fajkovic
- Department of Urology, Landesklinikum St.Poelten, Sankt Poelten, Austria
| | - Andreas Becker
- Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | | | - Michael Herman
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Paul Schramek
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria
| | - Wolfgang Loidl
- Prostate cancer center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria
| | | | - Morgan Rouprêt
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médicine Pierre et Marie Curie, Paris, France
| | | | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Markus Graefen
- Prostate cancer center, Martini-Clinic, Hamburg, Germany
| | - Ashutosh K Tewari
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna, Austria.
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Seiler R, Thalmann GN, Zehnder P. Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution. Res Rep Urol 2013; 5:121-8. [PMID: 24400243 PMCID: PMC3826931 DOI: 10.2147/rru.s32333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pelvic lymph node dissection (PLND) in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN) staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.
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Affiliation(s)
- Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | | | - Pascal Zehnder
- Department of Urology, University of Bern, Bern, Switzerland
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68
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Yoruk O, Yuksel R, Yuksel Y, Dane S. Left-right asymmetry in neck lymph nodes distribution in patients with bilateral laryngeal cancer. Surg Radiol Anat 2013; 36:239-42. [PMID: 23897538 DOI: 10.1007/s00276-013-1176-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to examine left-right asymmetry in involved and total neck lymph nodes distribution in patients with bilateral laryngeal cancer in the present study. METHODS Forty-six patients with bilateral laryngeal cancer was included the study. The oncologic database of our otorhinolaryngology department was used. The right and left lymph node with and without involvement by cancer cells counts were retrieved from pathological reports. RESULTS The numbers of both involved and total neck lymph nodes were significantly higher on right side than on left side for all neck levels in laryngeal malignancies. CONCLUSIONS The results of the present study suggest the existence of a left-right asymmetry in neck lymph node distribution and in the neck lymph node distribution involved by laryngeal cancer cells. The stronger cell-mediated immune activity in the left side of humans may be associated with the blocking of the metastatic invasion of cancer cells from laryngeal malignancies in the left body side.
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Affiliation(s)
- Ozgur Yoruk
- Department of Otorhinolaryngology, Ataturk University, Faculty of Medicine, Erzurum, Turkey
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69
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Kusuda Y, Miyake H, Kurahashi T, Fujisawa M. Assessment of optimal target genes for detecting micrometastases in pelvic lymph nodes in patients with prostate cancer undergoing radical prostatectomy by real-time reverse transcriptase-polymerase chain reaction. Urol Oncol 2013; 31:615-21. [DOI: 10.1016/j.urolonc.2011.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/19/2011] [Accepted: 04/10/2011] [Indexed: 12/09/2022]
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70
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Critical analysis and validation of lymph node density as prognostic variable in urothelial carcinoma of bladder. Urol Oncol 2013; 31:480-6. [DOI: 10.1016/j.urolonc.2011.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/31/2011] [Accepted: 02/16/2011] [Indexed: 11/23/2022]
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71
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Ploussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, Sulser T, Tewari AK, Eastham JA. Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 2013; 65:7-16. [PMID: 23582879 DOI: 10.1016/j.eururo.2013.03.057] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/25/2013] [Indexed: 11/15/2022]
Abstract
CONTEXT Pelvic lymph node dissection (PLND) in prostate cancer is the most effective method for detecting lymph node metastases. However, a decline in the rate of PLND during radical prostatectomy (RP) has been noted. This is likely the result of prostate cancer stage migration in the prostate-specific antigen-screening era, and the introduction of minimally invasive approaches such as robot-assisted radical prostatectomy (RARP). OBJECTIVE To assess the efficacy, limitations, and complications of PLND during RARP. EVIDENCE ACQUISITION A review of the literature was performed using the Medline, Scopus, and Web of Science databases with no restriction of language from January 1990 to December 2012. The literature search used the following terms: prostate cancer, radical prostatectomy, robot-assisted, and lymph node dissection. EVIDENCE SYNTHESIS The median value of nodal yield at PLND during RARP ranged from 3 to 24 nodes. As seen in open and laparoscopic RP series, the lymph node positivity rate increased with the extent of dissection during RARP. Overall, PLND-only related complications are rare. The most frequent complication after PLND is symptomatic pelvic lymphocele, with occurrence ranging from 0% to 8% of cases. The rate of PLND-associated grade 3-4 complications ranged from 0% to 5%. PLND is associated with increased operative time. Available data suggest equivalence of PLND between RARP and other surgical approaches in terms of nodal yield, node positivity, and intraoperative and postoperative complications. CONCLUSIONS PLND during RARP can be performed effectively and safely. The overall number of nodes removed, the likelihood of node positivity, and the types and rates of complications of PLND are similar to pure laparoscopic and open retropubic procedures.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, Saint-Louis Hospital, APHP, Paris, France; Department of Urology, Jewish General Hospital and Montreal General Hospital, McGill University, Montreal, Canada; INSERM 955, Team 7, University Paris 12, Créteil, France.
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72
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Outcomes and complications of pelvic lymph node dissection during robotic-assisted radical prostatectomy. World J Urol 2013; 31:481-8. [DOI: 10.1007/s00345-013-1056-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/07/2013] [Indexed: 12/25/2022] Open
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73
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Eden CG, Zacharakis E, Bott S. The learning curve for laparoscopic extended pelvic lymphadenectomy for intermediate- and high-risk prostate cancer: implications for compliance with existing guidelines. BJU Int 2013; 112:346-54. [DOI: 10.1111/j.1464-410x.2012.11671.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Simon Bott
- Department of Urology; Frimley Park Hospital; Frimley; UK
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74
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Robot-Assisted Laparoscopic Prostatectomy: Nodal Dissection Results During the First 440 Cases by Two Surgeons. J Endourol 2012; 26:1618-24. [DOI: 10.1089/end.2012.0360] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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75
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Jung JH, Seo JW, Lim MS, Lee JW, Chung BH, Hong SJ, Song JM, Rha KH. Extended Pelvic Lymph Node Dissection Including Internal Iliac Packet Should Be Performed During Robot-Assisted Laparoscopic Radical Prostatectomy for High-Risk Prostate Cancer. J Laparoendosc Adv Surg Tech A 2012; 22:785-90. [DOI: 10.1089/lap.2011.0516] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joo Wan Seo
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
| | - Meng Shi Lim
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
| | - Jae Won Lee
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
| | - Jae Mann Song
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
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76
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Daimon T, Miyajima A, Maeda T, Hattori S, Yasumizu Y, Hasegawa M, Kosaka T, Kikuchi E, Nakagawa K, Oya M. Does Pelvic Lymph Node Dissection Improve the Biochemical Relapse-Free Survival in Low-Risk Prostate Cancer Patients Treated by Laparoscopic Radical Prostatectomy? J Endourol 2012; 26:1199-202. [DOI: 10.1089/end.2011.0589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tatsuaki Daimon
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Maeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Hattori
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Hasegawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Nakagawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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77
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Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy? World J Urol 2012; 30:807-14. [DOI: 10.1007/s00345-012-0910-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022] Open
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78
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Sagalovich D, Calaway A, Srivastava A, Sooriakumaran P, Tewari AK. Assessment of required nodal yield in a high risk cohort undergoing extended pelvic lymphadenectomy in robotic-assisted radical prostatectomy and its impact on functional outcomes. BJU Int 2012; 111:85-94. [DOI: 10.1111/j.1464-410x.2012.11351.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Daniel Sagalovich
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer; James Buchanan Brady Foundation Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York; NY; USA
| | - Adam Calaway
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer; James Buchanan Brady Foundation Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York; NY; USA
| | - Abhishek Srivastava
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer; James Buchanan Brady Foundation Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York; NY; USA
| | - Prasanna Sooriakumaran
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer; James Buchanan Brady Foundation Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York; NY; USA
| | - Ashutosh K. Tewari
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer; James Buchanan Brady Foundation Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York; NY; USA
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79
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Yoon JY, Kryvenko ON, Ghani KR, Bertucci C, Menon M, Gupta NS. Characteristics of Pelvic Lymph Node Metastases in Prostatic Adenocarcinoma. Int J Surg Pathol 2012; 20:449-54. [DOI: 10.1177/1066896912445921] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pelvic lymph node dissection (PLND) is currently the most accurate staging modality for lymph node metastases in prostate adenocarcinoma. There is no consensus on the optimal sampling method of PLND specimens among pathologists. This study analyzed the effectiveness of the submission of entire adipose tissue in 451 cases and its impact on total lymph node yield and detection of positive lymph nodes. The sizes of metastatic foci and positive lymph nodes in 83 cases were also studied. Submission of entire adipose tissue increased the lymph node yield and positive lymph node detection by 36.7 % and 1.99 %, respectively. Three cases had positive lymph nodes exclusively in adipose tissue. Of the patients examined, 68% had the largest positive lymph node, <1 cm. In conclusion, it was noted that metastases from prostate cancer were frequently small and seen within small lymph nodes. Submission of entire adipose tissue substantially increased the lymph node yield, but its impact on the detection of additional positive lymph nodes was low. Submission of the entire adipose tissue may be considered as an option in patients with high-risk factors for lymph node metastases.
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Affiliation(s)
| | | | | | | | - Mani Menon
- Henry Ford Health System, Detroit, MI, USA
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80
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Larré S, Quintens H, Houéde N, Compérat E, Roy C, Pignot G, Rouprêt M, Neuzillet Y, Wallerand H, Soulié M, Pfister C. Intérêt du curage ganglionnaire dans les tumeurs urothéliales infiltrantes de la vessie (TVIM) et de la voie excrétrice supérieure (TVES) : article de revue du Comité de cancérologie de l’Association française d’urologie. Prog Urol 2012; 22:380-7. [DOI: 10.1016/j.purol.2012.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/02/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
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81
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Robotic Extended Pelvic Lymphadenectomy for Intermediate- and High-Risk Prostate Cancer. Eur Urol 2012; 61:1004-10. [PMID: 22366188 DOI: 10.1016/j.eururo.2012.01.048] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/27/2012] [Indexed: 11/24/2022]
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82
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Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI. Lymph node count threshold for optimal pelvic lymph node staging in prostate cancer. Int J Urol 2012; 19:645-51. [DOI: 10.1111/j.1442-2042.2012.02993.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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83
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[Lymphadenectomy for bladder cancer: current status and controversies]. Urologe A 2012; 51:310-8. [PMID: 22399109 DOI: 10.1007/s00120-012-2833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pelvic lymph node dissection is an integral part of the radical cystectomy procedure for patients with muscle-invasive bladder cancer. The optimal extent of the lymphadenectomy (LND) and mainly the proximal template boundary remain controversial issues. In view of the existing mapping studies and retrospective analyses, extended LND up to the mid-upper third of the common iliac vessels appears to provide further prognostic and therapeutic benefit and therefore should be defined as standard LND. This applies for all procedures irrespective of the choice of surgical approach (open surgery, minimally invasive approach). In this context total lymph node count is not a quality criterion because nodal yield is overly influenced by the individual patient's anatomy, surgical technique, template applied and pathological work-up. Consecutively, considerable inter-institutional differences result, which render any comparison impossible. Lymph node density is thought to be a superior prognostic factor, but it is similarly influenced by the above-mentioned factors. Concerning molecular techniques to improve the sensitivity of postoperative nodal staging further research is necessary. The two ongoing prospective randomized trials will potentially help to further define the optimal LND template.
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84
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Adams J, Cheng L. Lymph node-positive prostate cancer: current issues, emerging technology and impact on clinical outcome. Expert Rev Anticancer Ther 2012; 11:1457-69. [PMID: 21929319 DOI: 10.1586/era.11.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lymph node metastasis in patients with prostate cancer indicates a poorer prognosis compared with patients without lymph node metastasis; however, some patients with node-positive disease have long-term survival. Many studies have attempted to discern what characteristics of lymph node metastasis are prognostically significant. These characteristics include nodal tumor volume, number of positive lymph nodes, lymph node density, extranodal extension, lymphovascular invasion and tumor dedifferentiation. Favorable characteristics of regional lymph node involvement included a smaller tumor size and smaller tumor volume. However, the current staging system for prostate cancer does not provide different subclassifications for patients with node-positive prostate cancer. In recent years numerous advanced technologies for the detection of lymph node metastasis have been developed, including molecular imaging techniques and the CellSearch Circulating Tumor Cell System. With the increased detection of patients with prostate cancer, emergence of new technology to identify lymph node metastasis and the number of radical prostatectomies being performed on the rise, subclassifying patients with lymph node-positive disease is imperative. Subclassification would provide a better picture of patient prognosis and allow for a better understanding of targeted therapies to treat patients with lymph node metastasis.
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Affiliation(s)
- Julia Adams
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 West 11th Street, IUHPL 4010, Indianapolis, IN 46202, USA
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85
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Role and Extent of Lymphadenectomy During Radical Cystectomy for Invasive Bladder Cancer. Curr Urol Rep 2012; 13:115-21. [DOI: 10.1007/s11934-012-0235-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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86
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Cheng L, Montironi R, Bostwick DG, Lopez-Beltran A, Berney DM. Staging of prostate cancer. Histopathology 2011; 60:87-117. [DOI: 10.1111/j.1365-2559.2011.04025.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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87
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Meijer RP, Meijer RPP, Nunnink CJM, Wassenaar AE, Bex A, van der Poel HG, van Rhijn BW, Meinhardt W, Horenblas S. Standard lymph node dissection for bladder cancer: significant variability in the number of reported lymph nodes. J Urol 2011; 187:446-50. [PMID: 22177147 DOI: 10.1016/j.juro.2011.10.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared the nodal yield after histopathological examination of extended bilateral pelvic lymph node dissection specimens for bladder cancer at 2 hospitals. Surgery at each hospital was done by the same 4 staff urologists using a standardized extended bilateral pelvic lymph node dissection template. MATERIALS AND METHODS All consecutive patients with bladder cancer who underwent extended bilateral pelvic lymph node dissection from January 1, 2007 to December 31, 2009 were included in this study. Specimens were sent for pathological evaluation in a minimum of 2 packages per side. At the 2 pathology departments specimens were processed according to institutional protocols. RESULTS A total of 174 patients with a mean age of 62.7 years were included in analysis. At hospital 1 a mean of 16 lymph nodes were found after dissection vs a mean of 28 reported at hospital 2 (p <0.001). No significant differences were found in the number of tumor positive lymph nodes (p = 0.65). Mean lymph node density at hospitals 1 and 2 was 9.3% and 3.9%, respectively (p = 0.056). CONCLUSIONS Despite equal anatomical clearance by the same experienced surgeons we report a statistically significant difference between 2 pathology departments where the number of lymph nodes was evaluated after extended bilateral pelvic lymph node dissection for bladder cancer. Unless standardized methods are agreed on by pathologists, the number of reported lymph nodes as an indicator of surgical quality and lymph node density as a prognostic factor should be used cautiously.
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Affiliation(s)
- R P Meijer
- Department Of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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88
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Sense and nonsense of an extended pelvic lymph node dissection in prostate cancer. Adv Urol 2011; 2012:983058. [PMID: 22007203 PMCID: PMC3189454 DOI: 10.1155/2012/983058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/12/2011] [Indexed: 11/17/2022] Open
Abstract
Lymph node metastases associated with prostate cancer (PCa) has been shown to be a poor prognostic factor. The role of pelvic lymph node dissection (PLND) itself in relation to survival remains unclear, however. A Medline search was conducted to address this issue. The following conclusions were drawn. Only recently, improved survival due to completion of radical prostatectomy (RP) (compared to abandoning RP) in known or presumed lymph-node-positive patients has been shown. Lymph node sampling can only be considered representative if an adequate number of nodes is removed. While several authors have suggested that a therapeutic benefit in patients undergoing RP is not provided by PLND, the reliability of these studies is uncertain. Contrary to this, several studies have indicated the possibility of long-term survival even in the presence of limited lymph node metastases. The role and timing of initiation of adjuvant androgen deprivation therapy (ADT) in patients who have node-positive disease after RP is controversial. Recent studies suggest that delaying ADT may not adversely impact survival.
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89
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Pelvic lymphadenectomy in the treatment of invasive bladder cancer: literature review. Adv Urol 2011; 2011:701481. [PMID: 21904544 PMCID: PMC3166563 DOI: 10.1155/2011/701481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 05/15/2011] [Indexed: 11/23/2022] Open
Abstract
The standard surgical treatment of invasive bladder cancer is the radical cystectomy and pelvic lymph node dissection (PLND). Up to one-third of patients with invasive bladder cancer have lymph node metastasis. Thus, PLND has important therapeutic and prognostic benefits. The number of lymph nodes that should be removed and the extent of the PLND are still a controversial issue. Recently, the trend of PLND increased toward more
extended PLND. Several prognostic factors related to PLND were reported in the literature. In this paper, we will discuss the different PLND templates, number of lymph nodes that should be resected, lymph node density, lymphovascular invasion, tumor burden, extracapsular extension, and the aggregate lymph node metastasis diameter.
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90
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Joung JY, Cho IC, Lee KH. Role of pelvic lymph node dissection in prostate cancer treatment. Korean J Urol 2011; 52:437-45. [PMID: 21860762 PMCID: PMC3151629 DOI: 10.4111/kju.2011.52.7.437] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 03/07/2011] [Indexed: 11/18/2022] Open
Abstract
Pelvic lymph node dissection (PLND) is the most accurate and reliable staging procedure for detecting lymph node invasion (LNI) in prostate cancer. Recently, [(11)C]-choline positron emission tomography imaging and magnetic resonance imaging with lymphotropic superpara-magnetic nanoparticles have shown potential for detecting LNI but are still under investigation. The risk of LNI in low-risk groups could be underestimated by use of the current nomograms, which rely on data collected from patients who underwent only limited PLND. Extended PLND (ePLND) shows higher lymph node yield, which leads to the removal of more positive nodes and fewer missed positive nodes. It may be possible to refrain from performing PLND on low-risk patients with a prostate-specific antigen value <10 ng/ml and a biopsy Gleason score ≤6, but the risk of biopsy-related understaging should be kept in mind. Theoretically, meticulous ePLND may also impact prostate cancer survival by clearing low-volume diseases and occult micrometastasis even in pN0. The therapeutic role of PLND in prostate cancer patients is still an open question, especially in individuals with low-risk disease. Patients with intermediate- to high-risk disease are more likely to benefit from ePLND.
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Affiliation(s)
- Jae Young Joung
- Center for Prostate Cancer, National Cancer Center, Goyang, Korea
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91
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Bodin T, Boutin JM, Haillot O, Bruyere F. Le curage ilio-obturateur dans le cancer de la prostate doit-il être réalisé par voie cœlioscopique ? Prog Urol 2011; 21:463-9. [DOI: 10.1016/j.purol.2010.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/18/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
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92
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Miki J, Egawa S. The role of lymph node dissection in the management of prostate cancer. Int J Clin Oncol 2011; 16:195-202. [PMID: 21556799 DOI: 10.1007/s10147-011-0245-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Indexed: 11/28/2022]
Abstract
Lymph node dissection is a standard procedure for treatment of several cancers, but its role in prostate cancer (PCa) as an adjunct of radical prostatectomy is still debated and controversial. Pelvic lymph node dissection (PLND) is currently the most reliable means of diagnosis of lymph node metastases. A uniform PLND surgical template cannot be determined, but recent evidence shows that extended PLND provides more lymph nodes, increases the accuracy of detection of lymph node metastases, and affects decision making with regard to adjuvant therapy. Several nomograms have been developed to predict those who may need more extensive PLND, while sparing the rest. Importantly, no prospective data indicate that extension of PLND improves cancer control or benefits survival. A well designed prospective randomized study is needed to resolve these issues. We present a comprehensive literature review and critical discussion of the diagnostic and therapeutic role of PLND in PCa.
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Affiliation(s)
- Jun Miki
- Department of Urology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Seiler R, von Gunten M, Thalmann GN, Fleischmann A. Extracapsular extension but not the tumour burden of lymph node metastases is an independent adverse risk factor in lymph node-positive bladder cancer. Histopathology 2011; 58:571-8. [DOI: 10.1111/j.1365-2559.2011.03778.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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94
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May M, Herrmann E, Bolenz C, Brookman-May S, Tiemann A, Moritz R, Fritsche HM, Burger M, Trojan L, Michel MS, Wülfing C, Müller SC, Ellinger J, Buchner A, Stief CG, Tilki D, Wieland WF, Gilfrich C, Höfner T, Hohenfellner M, Haferkamp A, Roigas J, Zacharias M, Bastian PJ. Association between the number of dissected lymph nodes during pelvic lymphadenectomy and cancer-specific survival in patients with lymph node-negative urothelial carcinoma of the bladder undergoing radical cystectomy. Ann Surg Oncol 2011; 18:2018-25. [PMID: 21246405 DOI: 10.1245/s10434-010-1538-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND A larger number of dissected lymph nodes (LN) during pelvic lymphadenectomy in patients with muscle-invasive transitional-cell carcinoma of the bladder treated by radical cystectomy (RC) is crucial for exact tumor staging and is associated with a positive oncological outcome. METHODS Clinical and pathological records of 1291 patients undergoing RC due to LN-negative transitional-cell carcinoma of the bladder were summarized and evaluated in a multi-institutional database. The number of removed LNs and the presence or absence of lymphovascular invasion were assessed. On the basis of multivariate Cox regression analyses, a threshold number of removed LNs was defined that exerted an independent influence on cancer-specific survival (CSS). RESULTS In multivariate Cox regression models for different numbers of removed LNs, a statistically significant enhancement of CSS could be demonstrated for a LN count of 16. Furthermore, the integration of the dichotomized LN count of 16 resulted in a statistically significantly enhanced predictive ability of the model for CSS. Patients with <16 and ≥16 removed LNs showed CSS rates after 5 years of 72% and 83%, respectively (P = 0.01). In addition, age, sex, pT stage, and lymphovascular invasion had independent influences on CSS in every Cox regression model. CONCLUSIONS In patients undergoing RC, removal of a higher LN count is associated with an improved oncological outcome. The information resulting from an assessment of lymphovascular invasion and an extended lymphadenectomy is critical for stratification of risk groups and identification of patients who might benefit from adjuvant treatment.
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Affiliation(s)
- Matthias May
- Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany.
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95
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Berney DM, Wheeler TM, Grignon DJ, Epstein JI, Griffiths DF, Humphrey PA, van der Kwast T, Montironi R, Delahunt B, Egevad L, Srigley JR. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes. Mod Pathol 2011; 24:39-47. [PMID: 20818343 DOI: 10.1038/modpathol.2010.160] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of pathological assessment in radical prostatectomy evaluation and improve the concordance of research series to allow more accurate assessment of patient prognosis.
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Affiliation(s)
- Daniel M Berney
- Department of Molecular Oncology and Imaging, St Bartholomew's Hospital Queen Mary University of London, London, UK.
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96
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Siemens DR. Why all prostate cancer surgery should include an adequate lymph node dissection. Can Urol Assoc J 2010; 4:427-9. [PMID: 21191508 DOI: 10.5489/cuaj.10185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- D Robert Siemens
- Associate Professor, Departments of Urology, Oncology, Anatomy and Cell Biology, Queen's University, Kingston, ON
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97
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Capitanio U, Pellucchi F, Gallina A, Briganti A, Suardi N, Salonia A, Abdollah F, Di Trapani E, Jeldres C, Cestari A, Karakiewicz PI, Montorsi F. How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications. BJU Int 2010; 107:1095-101. [PMID: 20880192 DOI: 10.1111/j.1464-410x.2010.09580.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To identify clinical and pathological variables that may help clinicians in predicting, preventing and managing lymphorrhoea and clinically significant lymphocoeles (CSL), which are reported complications after pelvic lymphadenectomy (PLND) and retropubic radical prostatectomy (RRP). PATIENTS AND METHODS • We prospectively analysed 552 consecutive men with prostate cancer who underwent RRP and PLND (2006-2008). • All patients had detailed clinical and pathological data prospectively recorded in an electronic database. Drains were removed when the amount of lymph was < 20 mL in the previous 24 h. A CSL was defined as the presence of a symptomatic lymphocoele requiring treatment. Lymphorrhoea was defined as the total amount of lymph drained by the drains until their removal. • Univariable and multivariable logistic regression models were used to test the association between all the predictors (age, body mass index, American Society of Anesthesiologists score, prostate volume, clinical stage, number of LNs removed, surgeon, pathological T and N stage) and the presence of CSL. • Univariable and multivariable linear regression models were also used to test the association between the available predictors and lymphorrhoea. RESULTS • The median (range) number of LNs removed was 20 (1-63). Both linear and logistic multivariable regression analysis showed that the number of removed LNs and age were the only two statistically significant predictors of total amount of lymphorrhoea and CSL after RRP and PLND (both P < 0.01). • Specifically, the risk of developing a CSL increased by 5% for every LN removed. Similarly, every year of age increased the risk of having CSL by 5%. • The most informative thresholds for predicting CSL were 65 years of age and 20 LNs removed. • External iliac lymphadenectomy resulted in a higher associated risk of lymphorrhoea and CLS relative to obturator LN removal (P= 0.001 vs P= 0.1, respectively). CONCLUSIONS • There was a positive association between the number of LNs removed and age at RRP with the amount of lymphorrhoea and the risk of developing a CSL. • The most informative thresholds in predicting CSL were 65 years of age and 20 LNs removed. External iliac lymphadenectomy resulted in a higher risk of lymphorrhoea and CLS relative to obturator LN removal.
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Affiliation(s)
- Umberto Capitanio
- Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan, Italy.
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98
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Eden C, Arora A. The number of negative pelvic lymph nodes removed does not affect the risk of biochemical failure after radical prostatectomy. BJU Int 2010; 105:1479-80. [PMID: 20518771 DOI: 10.1111/j.1464-410x.2010.09395_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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99
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Robot-assisted Pelvic Lymphadenectomy for Bladder Cancer—Where Have We Reached By 2009. Urology 2010; 75:1269-74. [DOI: 10.1016/j.urology.2009.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 10/29/2009] [Accepted: 11/06/2009] [Indexed: 11/22/2022]
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100
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