Stratifying prostate cancer patients by relative lymph node involvement: population- and modeling-based study.
Jan T Poleszczuk1, Peter A Johnstone2, Heiko Enderling1,2
1Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, 33612.
Cancer Medicine
|May 27, 2016
Summary
Prostate cancer (PCa) patients with positive lymph nodes show varying survival rates based on lymph node involvement percentage (%LN+). Stratifying by %LN+ is crucial for future clinical trials and understanding disease incurability in lymph node-positive PCa.
Area of Science:
- Oncology
- Cancer Research
- Prostate Cancer
Background:
- Approximately 10% of new prostate cancer (PCa) cases present with lymph node positivity (LN+).
- The inflection point (IP) of an inverse Gompertzian survival curve serves as a surrogate marker for disease incurability.
- Stratification of LN+ PCa patients is essential for accurate prognostication and treatment planning.
Purpose of the Study:
- To stratify the curability of different patient cohorts with pathologically positive lymph nodes in prostate cancer.
- To model survival curves based on varying percentages of lymph node involvement (%LN+) postoperatively.
- To calculate the associated inflection points (IPs) for different %LN+ strata.
Main Methods:
- Utilized data from the Surveillance, Epidemiology, and End Results (SEER) database for LN+ PCa patients.
- Selected patients who underwent radical prostatectomy.
- Modeled relative survival curves using inverse Gompertzian kinetics, stratifying patients into %LN+ groups: <10%, 10-40%, and ≥40%.
Main Results:
- Analyzed data for 5903 patients; overall 5, 10, and 15-year relative survival rates were 96%, 87%, and 76%.
- Calculated IPs: ~27 years for <10% LN+, ~10 years for 10-40% LN+, and ~7 years for ≥40% LN+.
- Demonstrated a decrease in 10-year relative survival from 97% (<10% LN+) to 71% (≥40% LN+).
Conclusions:
- Prostate cancer patients with lymph node involvement are not a homogenous group.
- Stratification by percentage of lymph node involvement (%LN+) is critical for future clinical trials.
- Improved therapies are needed for LN+ PCa, with stratification by %LN+ enhancing treatment efficacy and research.
