Risk Stratification of Prostatic Adenocarcinoma Metastatic to the Lymph Nodes
Samuel Bidot1, Ashley Monsrud1, Meredith Kline2
1From the Department of Pathology and Laboratory Medicine (Bidot, Monsrud, Dent, Tinsley, Harik), Emory University School of Medicine, Atlanta, Georgia.
Archives of Pathology & Laboratory Medicine
|February 10, 2022
Summary
Prostate cancer patients with pN1 stage and two or more positive lymph nodes have a significantly higher risk of recurrence. Further stratification of lymph node metastasis can improve patient follow-up and treatment strategies.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Prostatic adenocarcinoma nodal staging is currently binary (pN0/pN1).
- Metastasis to nonregional lymph nodes is staged as pM1a.
- The extent of nodal tumor burden in pN1 patients requires further risk stratification.
Purpose of the Study:
- To determine the risk of recurrence in pN1 prostatic adenocarcinoma patients.
- To assess the impact of nodal tumor burden on disease-free survival.
Main Methods:
- Retrospective review of 96 pN1 prostatic adenocarcinoma patients treated with radical prostatectomy (2011-2019).
- Kaplan-Meier and Cox regression analyses were used to evaluate disease-free survival.
- Univariate and multivariate analyses identified predictors of unfavorable outcomes.
Main Results:
- Patients with ≥2 positive regional lymph nodes had a 3.03 times higher likelihood of an unfavorable outcome (P = .005).
- Tumor deposit size ≥2 mm and age >65 years were also associated with unfavorable outcomes on univariate analysis.
- Disease-free survival was similar between pN1M1a and pN1M0 stages when controlling for the number of positive lymph nodes.
Conclusions:
- Patients with pN1 prostatic adenocarcinoma and ≥2 positive lymph nodes face a significantly increased risk of unfavorable outcomes.
- Stratifying pN1 patients into prognostically significant risk categories is recommended.
- This stratification can aid clinicians in tailoring patient follow-up and therapy.
