Universität zu Köln

Bravi, Carlo A., Fossati, Nicola, Gandaglia, Giorgio, Suardi, Nazareno ORCID: 0000-0002-4331-3010, Mazzone, Elio, Robesti, Daniele ORCID: 0000-0001-6486-2169, Osmonov, Daniar, Juenemann, Klaus-Peter, Boeri, Luca, Karnes, R. Jeffrey, Kretschmer, Alexander, Buchner, Alexander ORCID: 0000-0001-7895-7070, Stief, Christian, Hiester, Andreas, Nini, Alessandro ORCID: 0000-0002-2548-6495, Albers, Peter, Devos, Gaetan, Joniau, Steven, Van Poppel, Hendrik, Shariat, Shahrokh F., Heidenreich, Axel, Pfister, David, Tilki, Derya, Graefen, Markus, Gill, Inderbir S., Mottrie, Alexander, Karakiewicz, Pierre, I, Montorsi, Francesco and Briganti, Alberto (2020). Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Not as Good as Previously Thought. Eur. Urol., 78 (5). S. 661 - 670. AMSTERDAM: ELSEVIER. ISSN 1873-7560

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Abstract

Background: Long-term outcomes of patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer (PCa) remain unknown. Objective: To investigate long-term oncological outcomes after sLND in a large multiinstitutional series. Design, setting, and participants: The study included 189 patients who experienced prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy (RP) and underwent sLND at 11 tertiary referral centers between 2002 and 2011. Lymph node recurrence was documented by positron emission tomography/computed tomography (PET/CT) scan using either C-11-choline or Ga-68 prostate-specific membrane antigen ligand. Outcome measurements and statistical analysis: The primary outcome of the study was cancer-specific mortality (CSM). The secondary outcomes were overall mortality, clinical recurrence (CR), biochemical recurrence (BCR), and androgen deprivation therapy (ADT)-free survival after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. Cox regression analysis was used to predict the risk of prostate CSM after accounting for several parameters, including the use of additional treatments after sLND. Results and limitations: At long term, 110 and 163 patients experienced CR and BCR, respectively, with CR-free and BCR-free survival at 10 yr of 31% and 11%, respectively. After sLND, a total of 145 patients received ADT, with a median time to ADT of 41 mo. At a median (interquartile range) follow-up for survivors of 87 (51, 104) mo, 48 patients died. Of them, 45 died from PCa. The probabilities of freedom from cancer-specific and all-cause death at 10 yr were 66% and 64%, respectively. Similar results were obtained in sensitivity analyses in patients with pelvic-only positive PET/CT scan, as well as after excluding men on ADT at PET/CT scan and patients with PSA level at sLND higher than the 75th percentile. At multivariable analyses, patients who had PSA response after sLND (hazard ratio [HR]: 0.45; p = 0.001), and those receiving ADT within 6 mo from sLND (HR: 0.51; p = 0.010) had lower risk of death from PCa. Conclusions: A third of men treated with sLND for PET-detected nodal recurrence of PCa died at long term, with PCa being the main cause of death. Salvage LND alone was associated with durable long-term outcomes in a minority of men who significantly benefited from additional treatments after surgery. Taken together, all these data argue against the use of metastasis-directed therapy alone for patients with node-only recurrent PCa. These men should instead be considered at high risk of systemic dissemination already at the time of sLND. Patient summary: We assessed long-term outcomes of patients treated with salvage lymph node dissection (sLND) for node-recurrent prostate cancer (PCa). In contrast with priorevidence, we found that the majority of these men recurred after sLND and eventually died from PCa. A significant survival benefit associated with the administration of androgen deprivation therapy after sLND suggests that sLND should be considered part of a multimodal approach rather than an exclusive treatment strategy. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bravi, Carlo A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fossati, Nicola UNSPECIFIED UNSPECIFIED UNSPECIFIED Gandaglia, Giorgio UNSPECIFIED UNSPECIFIED UNSPECIFIED Suardi, Nazareno UNSPECIFIED orcid.org/0000-0002-4331-3010 UNSPECIFIED Mazzone, Elio UNSPECIFIED UNSPECIFIED UNSPECIFIED Robesti, Daniele UNSPECIFIED orcid.org/0000-0001-6486-2169 UNSPECIFIED Osmonov, Daniar UNSPECIFIED UNSPECIFIED UNSPECIFIED Juenemann, Klaus-Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Boeri, Luca UNSPECIFIED UNSPECIFIED UNSPECIFIED Karnes, R. Jeffrey UNSPECIFIED UNSPECIFIED UNSPECIFIED Kretschmer, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchner, Alexander UNSPECIFIED orcid.org/0000-0001-7895-7070 UNSPECIFIED Stief, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Hiester, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Nini, Alessandro UNSPECIFIED orcid.org/0000-0002-2548-6495 UNSPECIFIED Albers, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Devos, Gaetan UNSPECIFIED UNSPECIFIED UNSPECIFIED Joniau, Steven UNSPECIFIED UNSPECIFIED UNSPECIFIED Van Poppel, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Shariat, Shahrokh F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Tilki, Derya UNSPECIFIED UNSPECIFIED UNSPECIFIED Graefen, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Gill, Inderbir S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mottrie, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Karakiewicz, Pierre, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Montorsi, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Briganti, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-313877
DOI:	10.1016/j.eururo.2020.06.043
Journal or Publication Title:	Eur. Urol.
Volume:	78
Number:	5
Page Range:	S. 661 - 670
Date:	2020
Publisher:	ELSEVIER
Place of Publication:	AMSTERDAM
ISSN:	1873-7560
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language METASTASIS-DIRECTED THERAPY; BIOCHEMICAL RECURRENCE; IMPACT; EXPERIENCE; SURVIVAL; RISK Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31387