Martini-Klinik, prostate cancer centre, University hospital Hamburg-Eppendorf
Introduction: Nodal metastasis (N1) is a strong prognostic parameter in prostate cancer (PCa). The oncological outcome of patients without nodal metastases (N0) but with lymphatic invasion (L1) in the prostatectomy specimen seems to be comparable to N1 patients in terms of biochemical recurrence (BCR) according to current literature. Therefore, we retrospectively analysed the influence of L1 on the outcome of the radical prostatectomy (RP) patients. Methods: We identified 28,945 patients who underwent RP between April 2005 and December 2019 in our tertiary care centre. Of those, 27,329 consecutive patients were analysed. The impact of L1 was measured. The endpoints were BCR, disease progression (metastases) and cancer specific mortality (CSM). Results: Pelvic lymph node dissection was performed in 22,216 patients (81.3%). A median of eleven lymph nodes were dissected (interquartile range (IQR): 4 – 18). In 3,006 patients (11%) N1 status and in 4,216 patients (15.4%) L1 status was described. The median follow-up was 61 (IQR: 35 – 97.7) months. We identified 2,278 N0L1 patients, 199 NXL1 patients and 1,739 N1L1 patients. In uni- and multivariable Cox regression models, L1 was an independent predictor for BCR, disease progression and CSM (hazard ratio [HR]=1.43, 1.59 and 1.51; all p<0.008) as well as N status, pT stage, Gleason score and PSA. In Kaplan-Meier analyses, 120-months BCR-free survival, metastases-free survival and cancer-specific survival rates were significantly different between the groups (N0L0, N0L1; NXL0, NX L1; N1L0, N1L1; p<0.001). Conclusions: L1 has an independent impact on prognosis in PCa patients. Especially, in NX and N0 this might change treatment decisions. This information may prove valuable when risk stratifying based on final pathology SOURCE OF Funding: none
