Identifying low cancer-specific mortality risk lymph node-positive radical prostatectomy patients

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Radical prostatectomy (RP) is a common treatment for prostate cancer.
• Lymph node involvement (pN1) after RP indicates a higher risk of cancer recurrence and mortality.
• Accurate risk stratification is essential for personalized patient management and clinical trial design.

Purpose of the Study:

• To identify patients with lymph node-positive (pN1) radical prostatectomy (RP) who have a low risk of cancer-specific mortality (CSM).

Main Methods:

• Utilized the Surveillance, Epidemiology and End Results (SEER) database (2010-2015).
• Identified pN1 RP patients and analyzed pathological characteristics.
• Employed Kaplan-Meier plots and multivariable Cox-regression (MCR) models to assess CSM risk.

Main Results:

• Analyzed 2197 pN1 RP patients; overall 5-year cancer-specific survival (CSS) was 93.3%.
• Multivariable Cox-regression identified ISUP Grade Group (GG) 1-4, pT2-pT3b, and 1-2 positive lymph nodes as predictors of lower CSM.
• Defined a low-risk group (ISUP GG1-3, pT2-3a, 1-2 positive lymph nodes) with a 5-year CSS of 99.3% compared to 91.8% in others.

Conclusions:

• Lymph node-positive RP patients have variable CSS rates.
• Pathological characteristics, specifically ISUP GG1-3, pT2-3a, and 1-2 positive lymph nodes, can identify a subgroup with very low CSM risk.
• This stratification aids in patient counseling and clinical trial design for prostate cancer management.