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Int J Urol. 2016 Dec;23(12):1000-1008. doi: 10.1111/iju.13203. Epub 2016 Sep 12.

Predicting survival in node-positive prostate cancer after open, laparoscopic or robotic radical prostatectomy: A competing risk analysis of a multi-institutional database.

Author information

1
Department of Urology, University of Bologna, Bologna, Italy.
2
Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
3
Department of Urology, University of Florence, Florence, Italy.
4
Department of Urology, University of Genoa, Genoa, Italy.
5
Department of Urology, OLV Hospital, Aalst, Belgium.
6
Department of Urology, Abano Hospital, Padua, Italy.
7
Department of Urology, University of Turin, Turin, Italy.
8
Department of Urology, University of Naples, Naples, Italy.
9
Department of Nephrology, Dialysis, and Renal Transplant Unit, University of Bologna, Bologna, Italy.
10
Department of Urology, University of Eastern Piedmont, Novara, Italy.
11
Department of Urology, University of Ancona, Ancona, Italy.
12
Department of Urology, University of Catania, Catania, Italy.

Abstract

OBJECTIVES:

To investigate cancer-specific mortality and other-cause mortality in prostate cancer patients with nodal metastases.

METHODS:

The study included 411 patients treated with radical prostatectomy and pelvic lymph node dissection for prostate cancer with lymph node metastases at 10 tertiary care centers between 1995 and 2014. Kaplan-Meier analyses were used to assess cancer-specific mortality-free survival rates at 8 years' follow up in the overall population, and after stratifying patients according to clinical and pathological parameters. Uni- and multivariable competing risk Cox regression analyses were used to assess cancer-specific mortality and other-cause mortality. Finally, cumulative-incidence plots were generated for cancer-specific mortality and other-cause mortality after stratifying patients according to the number of positive lymph nodes and the median age at surgery, according to the competing risks method.

RESULTS:

Men with prostate-specific antigen ≤40 ng/mL and those with one to three positive lymph nodes showed higher cancer-specific mortality-free survival estimates as compared with their counterparts with prostate-specific antigen >40 ng/mL and >3 metastatic lymph nodes, respectively (all P < 0.001). At multivariable Cox regression analyses, preoperative prostate-specific antigen >40 ng/mL, >3 lymph node metastases and pathological Gleason score 8-10 were all independent predictors of cancer-specific mortality (all P-values ≤0.001). On competing risk analysis, when patients were stratified according to the number of positive lymph nodes (namely, ≤3 vs >3), the 8-year cancer-specific mortality rates were 27.4% versus 44.8% for patients aged <65 years, and 15.2% versus 52.6% for patients aged ≥65 years, respectively.

CONCLUSIONS:

Three positive lymph nodes represent the best prognostic cut-off in node-positive prostate cancer patients. In those individuals with >3 positive lymph nodes, the overall mortality rate is completely related to prostate cancer in young patients.

KEYWORDS:

cancer-specific mortality; competing risk analysis; lymph node metastases; other-cause mortality; radical prostatectomy

PMID:
27620370
DOI:
10.1111/iju.13203
[Indexed for MEDLINE]
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