TY - JOUR
T1 - Validation study on the 2 mm diameter cutoff in lymph node-positive cases following radical prostatectomy in accordance with the AJCC/UICC TNM 8th edition
T2 - Real-world data analysis from a Japanese cohort
AU - the Japanese Urological Oncology Group
AU - Kato, Masashi
AU - Shiota, Masaki
AU - Kimura, Takahiro
AU - Hanazawa, Ryoichi
AU - Hirakawa, Akihiro
AU - Takamatsu, Dai
AU - Tashiro, Kojiro
AU - Matsui, Yoshiyuki
AU - Hashine, Katsuyoshi
AU - Saito, Ryoichi
AU - Yokomizo, Akira
AU - Yamamoto, Yoshiyuki
AU - Narita, Shintaro
AU - Hashimoto, Kohei
AU - Matsumoto, Hiroaki
AU - Akamatsu, Shusuke
AU - Nishiyama, Naotaka
AU - Eto, Masatoshi
AU - Kitamura, Hiroshi
AU - Tsuzuki, Toyonori
N1 - Publisher Copyright:
© 2024 The Japanese Urological Association.
PY - 2024/6
Y1 - 2024/6
N2 - Objectives: The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) 8th edition has proposed micrometastasis as a lymph node metastasis (LN+) of diameter ≤2 mm in prostate cancer. However, supporting evidence has not described. We evaluated LN+ patients' survival after radical prostatectomy (RP) based on the LN maximum tumor diameter (MTD). Methods: Data from 561 LN+ patients after RP and pelvic LN dissection (PLND) treated between 2006 and 2019 at 33 institutions were retrospectively investigated. Patients were stratified by a LN+ MTD cutoff of 2 mm. Outcomes included castration resistance-free survival (CRFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Results: In total, 282 patients were divided into two groups (LN+ MTD >2 mm [n = 206] and ≤2 mm [n = 76]). Patients of LN+ status >2 mm exhibited significantly decreased CRFS and MFS, and poorer CSS and OS. No patients developed CRPC in the LN+ status ≤2 mm group when the PLND number was ≥14. Multivariate analysis showed the number of LN removed, RP Gleason pattern 5, and MTD in LN+ significantly predicted CRFS. Conclusions: Patients of LN+ status ≤2 mm showed better prognoses after RP. In all the patients in the ≤2-mm group, the progression to CRPC could be prevented with appropriate interventions, particularly when PLND is performed accurately. Our findings support the utility of the pN substaging proposed by the AJCC/UICC 8th edition; this will facilitate precision medicine for patients with advanced prostate cancer.
AB - Objectives: The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) 8th edition has proposed micrometastasis as a lymph node metastasis (LN+) of diameter ≤2 mm in prostate cancer. However, supporting evidence has not described. We evaluated LN+ patients' survival after radical prostatectomy (RP) based on the LN maximum tumor diameter (MTD). Methods: Data from 561 LN+ patients after RP and pelvic LN dissection (PLND) treated between 2006 and 2019 at 33 institutions were retrospectively investigated. Patients were stratified by a LN+ MTD cutoff of 2 mm. Outcomes included castration resistance-free survival (CRFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Results: In total, 282 patients were divided into two groups (LN+ MTD >2 mm [n = 206] and ≤2 mm [n = 76]). Patients of LN+ status >2 mm exhibited significantly decreased CRFS and MFS, and poorer CSS and OS. No patients developed CRPC in the LN+ status ≤2 mm group when the PLND number was ≥14. Multivariate analysis showed the number of LN removed, RP Gleason pattern 5, and MTD in LN+ significantly predicted CRFS. Conclusions: Patients of LN+ status ≤2 mm showed better prognoses after RP. In all the patients in the ≤2-mm group, the progression to CRPC could be prevented with appropriate interventions, particularly when PLND is performed accurately. Our findings support the utility of the pN substaging proposed by the AJCC/UICC 8th edition; this will facilitate precision medicine for patients with advanced prostate cancer.
KW - AJCC/UICC 8th edition
KW - lymph node metastasis
KW - micrometastasis
KW - prostate cancer
KW - radical prostatectomy
UR - http://www.scopus.com/inward/record.url?scp=85186944568&partnerID=8YFLogxK
U2 - 10.1111/iju.15434
DO - 10.1111/iju.15434
M3 - 学術論文
C2 - 38424729
AN - SCOPUS:85186944568
SN - 0919-8172
VL - 31
SP - 662
EP - 669
JO - International Journal of Urology
JF - International Journal of Urology
IS - 6
ER -