Concurrent prognostic utility of lymph node count and lymph node density for men with pathological node-positive
John M Masterson1, Michael Luu1,2, Aurash Naser-Tavakolian1
1Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Prostate Cancer and Prostatic Diseases
|January 4, 2023
Summary
For prostate cancer patients, the number of positive lymph nodes (+LN) is a more reliable predictor of overall mortality (OM) than lymph node density (LND). The impact of LND on OM is minimal for men with three or fewer positive lymph nodes.
Area of Science:
- Oncology
- Pathology
- Surgical Oncology
Background:
- Metastatic lymph nodes in prostate cancer impact mortality.
- Both the number (+LN) and density (LND) of positive lymph nodes are known prognostic factors.
- The independent contribution of +LN and LND to overall mortality (OM) requires clarification.
Purpose of the Study:
- To determine the independent impact of lymph node count and lymph node density on overall mortality in prostate cancer patients.
- To evaluate the non-linear association between +LN, LND, and OM.
Main Methods:
- Utilized data from the National Cancer Database (2004-2013) for men undergoing radical prostatectomy and lymphadenectomy.
- Employed multivariable Cox proportional hazards analysis with restricted cubic splines.
- Assessed the non-linear relationship between +LN count, LND, and OM.
Main Results:
- Overall mortality increased with additional positive lymph nodes up to four.
- Lymph node density independently predicted overall mortality.
- The predictive value of LND for OM was negligible in patients with three or fewer positive lymph nodes.
Conclusions:
- Lymph node count is a primary predictor of OM in prostate cancer.
- Lymph node density has a negligible impact on OM for the majority of patients with limited nodal metastasis (≤3 +LN).
- Pathological nodal staging should prioritize lymph node count over lymph node density.
