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. 2022 Jun 11;12(1):9675.
doi: 10.1038/s41598-022-13651-x.

Significance of pelvic lymph node dissection during radical prostatectomy in high-risk prostate cancer patients receiving neoadjuvant chemohormonal therapy

Hiromichi Iwamura  1 , Shingo Hatakeyama  2 , Takuma Narita  1 , Yusuke Ozaki  1 , Sakae Konishi  1 , Hirotaka Horiguchi  1 , Hirotake Kodama  1 , Yuta Kojima  1 , Naoki Fujita  1 , Teppei Okamoto  1 , Yuki Tobisawa  3 , Tohru Yoneyama  3 , Hayato Yamamoto  1 , Takahiro Yoneyama  3 , Yasuhiro Hashimoto  1 , Chikara Ohyama  1   4   3
Affiliations

Significance of pelvic lymph node dissection during radical prostatectomy in high-risk prostate cancer patients receiving neoadjuvant chemohormonal therapy

Hiromichi Iwamura et al. Sci Rep. .

Abstract

We aimed to determine the survival and staging benefit of limited pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in high-risk prostate cancer (PC) patients treated with neoadjuvant chemohormonal therapy. We retrospectively analyzed 516 patients with high-risk localized PC (< cT4N0M0) who received neoadjuvant androgen-deprivation therapy plus estramustine phosphate followed by RP between January 2010 and March 2020. Since we stopped limited PLND for such patients in October 2015, we compared the surgical outcomes and biochemical recurrence-free survival (BCR-FS) between the limited-PLND group (before October 2015, n = 283) and the non-PLND group (after November 2015, n = 233). The rate of node metastases in the limited-PLND group were 0.8% (2/283). Operation time was significantly longer (176 vs. 162 min) and the rate of surgical complications were much higher (all grades; 19 vs. 6%, grade ≥ 3; 3 vs. 0%) in the limited-PLND group. The inverse probability of treatment weighting-Cox analysis revealed limited PLND had no significant impact on BCR-FS (hazard ratio, 1.44; P = 0.469). Limited PLND during RP after neoadjuvant chemohormonal therapy showed quite low rate of positive nodes, higher rate of complications, and no significant impact on BCR-FS.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Operation time (a), blood loss (b), and surgical complications (c,d), between the limited-PLND and non-PLND groups (excluding RRP cases). PLND pelvic lymph node dissection, RARP robot-assisted radical prostatectomy, RRP retropubic radical prostatectomy. *Since surgical invasiveness and difficulty greatly differ between RRP and RARP, only RARP cases were included to examine the impact of PLND on surgical outcomes.
Figure 2
Figure 2
Number of dissected nodes stratified by age at surgery (a), anticoagulant use (b), surgery type (c), clinical tumor stage (d), and biopsy Gleason score (e) in the limited-PLND group. PLND pelvic lymph node dissection, RARP robot-assisted radical prostatectomy, RRP retropubic radical prostatectomy, ISUP GG the International Society of Urological Pathology grade group.
Figure 3
Figure 3
Unadjusted (a) and IPTW-adjusted biochemical recurrence-free survival (b), between the limited-PLND and non-PLND groups. IPTW inverse probability of treatment weighting, PLND pelvic lymph node dissection, PSA prostate-specific antigen.
See this image and copyright information in PMC

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