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Prognostic factors and the role of pelvic lymph node dissection in oligometastatic prostate cancer: a multicenter
Jieping Hu1, Yuyang Yuan2, Xinchang Zou3
1Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China. hu_jieping@ncu.edu.cn.
Background:
Oligometastatic prostate cancer (omPC) represents a specific state with improved outcomes following cytoreductive radical prostatectomy (cRP). Prognostic factors that guide disease progression are yet to be fully elucidated, and the role of pelvic lymph node dissection (LND) in this setting is controversial. This study aimed to evaluate the impact of LND on biochemical progression and castration-resistant prostate cancer (CRPC) in patients with omPC.
Methods:
A total of 169 omPC patients who underwent cRP with (n = 123) or without LND (n = 46) between January 2015 and February 2024 at multiple centers were retrospectively analyzed. Biochemical progression-free survival (bPFS) and time to CRPC were analyzed using Kaplan-Meier curves and Cox proportional hazards models. Subgroup analysis stratified by nodal status was performed to explore differential treatment effects.
Results:
In the overall cohort, multivariable analysis identified initial PSA > 30 ng/mL as an independent predictor of biochemical progression (HR = 2.53, 95% CI: 1.40-4.58, p = 0.002). For CRPC progression, no variable reached conventional statistical significance in the multivariable model. Stratified analysis revealed that among patients with node-positive disease (N1, n = 40), LND was associated with significantly prolonged bPFS (p = 0.018) and delayed progression to CRPC (p = 0.014). Notably, within the LND cohort (n = 123), N1 patients had significantly higher Gleason scores and T stages, and experienced worse CRPC than N0 patients (p = 0.02).
Conclusion:
In omPC patients undergoing cRP, high baseline PSA independently predicted biochemical recurrence. Nodal involvement was associated with more aggressive disease features and worse outcomes within the population. An exploratory subgroup analysis suggested that node-positive patients may be associated with improved outcomes after LND; however, this finding was limited by a very small sample size and requires prospective validation.