Influence of biopsy gleason score on the risk of lymph node invasion in patients with intermediate-risk prostate cancer undergoing radical prostatectomy

  • Objective: To analyze the influence of biopsy Gleason score on the risk for lymph node invasion (LNI) during pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy (RP) for intermediate-risk prostate cancer (PCa). Materials and Methods: We retrospectively analyzed 684 patients, who underwent RP between 2014 and June 2020 due to PCa. Univariable and multivariable logistic regression, as well as binary regression tree models were used to assess the risk of positive LNI and evaluate the need of PLND in men with intermediate-risk PCa. Results: Of the 672 eligible patients with RP, 80 (11.9%) men harbored low-risk, 32 (4.8%) intermediate-risk with international society of urologic pathologists grade (ISUP) 1 (IR-ISUP1), 215 (32.0%) intermediate-risk with ISUP 2 (IR-ISUP2), 99 (14.7%) intermediate-risk with ISUP 3 (IR-ISUP3), and 246 (36.6%) high-risk PCa. Proportions of LNI were 0, 3.1, 3.7, 5.1, and 24.0% for low-risk, IR-ISUP1, IR-ISUP 2, IR-ISUP-3, and high-risk PCa, respectively (p < 0.001). In multivariable analyses, after adjustment for patient and surgical characteristics, IR-ISUP1 [hazard ratio (HR) 0.10, p = 0.03], IR-ISUP2 (HR 0.09, p < 0.001), and IR-ISUP3 (HR 0.18, p < 0.001) were independent predictors for lower risk of LNI, compared with men with high-risk PCa disease. Conclusions: The international society of urologic pathologists grade significantly influence the risk of LNI in patients with intermediate- risk PCa. The risk of LNI only exceeds 5% in men with IR-ISUP3 PCa. In consequence, the need for PLND in selected patients with IR-ISUP 1 or IR-ISUP2 PCa should be critically discussed.

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Author:Mike WenzelORCiDGND, Felix PreißerORCiDGND, Robert Benedikt HöhORCiDGND, Maria-Noemi WelteGND, Clara Julia HumkeGND, Clarissa WittlerGND, Christoph WürnschimmelORCiDGND, Andreas BeckerGND, Pierre I. Karakiewicz, Felix ChunORCiDGND, Philipp MandelORCiDGND, Luis KluthORCiDGND
URN:urn:nbn:de:hebis:30:3-620651
DOI:https://doi.org/10.3389/fsurg.2021.759070
ISSN:2296-875X
Parent Title (English):Frontiers in Surgery
Publisher:Frontiers Media
Place of publication:Lausanne
Document Type:Article
Language:English
Date of Publication (online):2021/12/09
Date of first Publication:2021/12/09
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2024/04/29
Tag:Gleason score; intermediate risk; lymph node dissection; lymph node metastases; predictor; prostate cancer
Volume:8
Issue:art. 759070
Article Number:759070
Page Number:6
First Page:1
Last Page:6
HeBIS-PPN:521123550
Institutes:Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International