Universität zu Köln

Fossati, Nicola, Suardi, Nazareno, Gandaglia, Giorgio ORCID: 0000-0002-5052-721X, Bravi, Carlo A., Soligo, Matteo, Karnes, R. Jeffrey, Shariat, Shahrokh ORCID: 0000-0002-6627-6179, Battaglia, Antonino ORCID: 0000-0003-1961-8217, Everaerts, Wouter, Joniau, Steven ORCID: 0000-0003-3195-9890, van Poppel, Hendrik, Rajarubendra, Nieroshan, Gill, Inderbir S., Larcher, Alessandro ORCID: 0000-0002-5005-589X, Mottrie, Alexander, Schmautz, Maximilian, Heidenreich, Axel, Kalz, Almut, Osmonov, Daniar, Juenemann, Klaus-Peter, Herlemann, Annika, Gratzke, Christian, Stief, Christian, Montorsi, Francesco and Briganti, Alberto (2019). Identifying the Optimal Candidate for Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer: Results from a Large, Multi-institutional Analysis. Eur. Urol., 75 (1). S. 176 - 184. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 1873-7560

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Abstract

Background: Salvage lymph node dissection (SLND) represents a possible treatment option for prostate cancer patients affected by nodal recurrence after local treatment. However, SLND may be associated with intra-and postoperative complications, and the oncological benefit may be limited to specific groups of patients. Objective: To identify the optimal candidates for SLND based on preoperative characteristics. Design, setting, and participants: The study included 654 patients who experienced prostate-specific antigen (PSA) rise and nodal recurrence after radical prostatectomy (RP) and underwent SLND at nine tertiary referral centers. Lymph node recurrence was documented by positron emission tomography/computed tomography (PET/CT) scan using either C-11-choline or Ga-68-labeled prostate-specific membrane antigen ligand. Intervention: SLND. Outcome measurements and statistical analysis: The study outcome was early clinical recurrence (eCR) developed within 1 yr after SLND. Multivariable Cox regression analysis was used to develop a predictive model. Multivariable-derived coefficients were used to develop a novel risk calculator. Decision-curve analysis was used to evaluate the net benefit of the predictive model. Results and limitations: Median follow-up was 30 (interquartile range, 16-50) mo among patients without clinical recurrence (CR), and 334 patients developed CR after SLND. In particular, eCR at 1 yr after SLND was observed in 150 patients, with a Kaplan-Meier probability of eCR equal to 25%. The development of eCR was significantly associated with an increased risk of cancer-specific mortality at 3 yr, being 20% versus 1.4% in patients with and without eCR, respectively (p < 0.0001). At multivariable analysis, Gleason grade group 5 (hazard ratio [HR]: 2.04; p < 0.0001), time from RP to PSA rising (HR: 0.99; p = 0.025), hormonal therapy administration at PSA rising after RP (HR: 1.47; p = 0.0005), retroperitoneal uptake at PET/CT scan (HR: 1.24; p = 0.038), three or more positive spots at PET/CT scan (HR: 1.26; p = 0.019), and PSA level at SLND (HR: 1.05; p < 0.0001) were significant predictors of CR after SLND. The coefficients of the predictive model were used to develop a risk calculator for eCR at 1 yr after SLND. The discrimination of the model (Harrel's C index) was 0.75. At decision-curve analysis, the net benefit of the model was higher than the treat-all option at all the threshold probabilities. Conclusions: We reported the largest available series of patients treated with SLND. Roughly 25% of men developed eCR after surgery. We developed the first risk stratification tool to identify the optimal candidate to SLND based on routinely available preoperative characteristics. This tool can be useful to avoid use of SLND in men more likely to progress despite any imaging-guided approach. Patient summary: The risk of early recurrence after salvage lymph node dissection (SLND) was approximately 25%. In this study, we developed a novel tool to predict the risk of early failure after SLND. This tool will be useful to identify patients who would benefit the most from SLND from other patients who should be spared from surgery. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fossati, Nicola UNSPECIFIED UNSPECIFIED UNSPECIFIED Suardi, Nazareno UNSPECIFIED UNSPECIFIED UNSPECIFIED Gandaglia, Giorgio UNSPECIFIED orcid.org/0000-0002-5052-721X UNSPECIFIED Bravi, Carlo A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Soligo, Matteo UNSPECIFIED UNSPECIFIED UNSPECIFIED Karnes, R. Jeffrey UNSPECIFIED UNSPECIFIED UNSPECIFIED Shariat, Shahrokh UNSPECIFIED orcid.org/0000-0002-6627-6179 UNSPECIFIED Battaglia, Antonino UNSPECIFIED orcid.org/0000-0003-1961-8217 UNSPECIFIED Everaerts, Wouter UNSPECIFIED UNSPECIFIED UNSPECIFIED Joniau, Steven UNSPECIFIED orcid.org/0000-0003-3195-9890 UNSPECIFIED van Poppel, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Rajarubendra, Nieroshan UNSPECIFIED UNSPECIFIED UNSPECIFIED Gill, Inderbir S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Larcher, Alessandro UNSPECIFIED orcid.org/0000-0002-5005-589X UNSPECIFIED Mottrie, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmautz, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Kalz, Almut UNSPECIFIED UNSPECIFIED UNSPECIFIED Osmonov, Daniar UNSPECIFIED UNSPECIFIED UNSPECIFIED Juenemann, Klaus-Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Herlemann, Annika UNSPECIFIED UNSPECIFIED UNSPECIFIED Gratzke, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Stief, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Montorsi, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Briganti, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-140951
DOI:	10.1016/j.eururo.2018.09.009
Journal or Publication Title:	Eur. Urol.
Volume:	75
Number:	1
Page Range:	S. 176 - 184
Date:	2019
Publisher:	ELSEVIER SCIENCE BV
Place of Publication:	AMSTERDAM
ISSN:	1873-7560
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BIOCHEMICAL RECURRENCE; ADJUVANT RADIOTHERAPY; PET/CT; SURVIVAL; IMPACT; SITE; PSA Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14095