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Pelvic Lymph Node Dissection in Prostate Cancer: Update from a Randomized Clinical Trial of Limited Versus Extended
Karim A Touijer1, Emily A Vertosick2, Daniel D Sjoberg2
1Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
European Urology
|October 29, 2024
Summary
Extended pelvic lymph node dissection (PLND) during prostatectomy significantly reduces metastasis risk compared to limited PLND. This finding supports broader application of extended PLND in cancer surgery.
Area of Science:
- Urology
- Surgical Oncology
- Clinical Trials
Background:
- Lymph node dissection (LND) is a standard cancer surgery, but randomized trial evidence for its benefit is limited.
- Previous findings showed comparable biochemical recurrence (BCR) rates between limited and extended pelvic LND (PLND) during radical prostatectomy.
Purpose of the Study:
- To compare updated BCR rates and metastasis rates between limited and extended PLND in radical prostatectomy patients.
- To evaluate the impact of PLND extent on metastasis development following prostatectomy.
Main Methods:
- A single-center, clinically integrated randomized trial involving 1432 patients undergoing radical prostatectomy.
- Surgeons were cluster-randomized to limited (external iliac) or extended (external iliac, obturator, hypogastric) PLND.
- Cox proportional-hazards regression was used to analyze BCR and metastasis rates.
Main Results:
- Updated analysis confirmed comparable BCR rates between limited and extended PLND (HR 1.05, p=0.3).
- Extended PLND demonstrated a significant protective effect against any metastasis (HR 0.82, p=0.003) and distant metastasis (HR 0.75, p<0.001).
- Median follow-up was 4.2 years for BCR and 5.4 years for metastasis.
Conclusions:
- Extended PLND, encompassing external iliac, obturator, and hypogastric nodes, is recommended for patients undergoing radical prostatectomy.
- Further research into the biological mechanisms of nodal metastasis location is warranted.
- The study design may inform future LND trials for other cancers.
