Lymphatic micrometastases predict biochemical recurrence in patients undergoing radical prostatectomy and pelvic lymph node dissection for prostate cancer

Author:

Maxeiner Andreas1,Grevendieck Andreas1,Pross Therese1,Rudl Marc2,Arnold Alexander2,Stephan Carsten13,Jung Klaus13,Miller Kurt1,Kilic Ergin24,Busch Jonas1

Affiliation:

1. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Urologie, Campus Mitte, Berlin

2. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Pathologie, Campus Mitte, Berlin

3. Berlin Institute for Urologic Research, Berlin

4. Institute of Pathology, Klinikum Leverkusen, Leverkusen

Abstract

Abstract Background Nodal metastasis is a strong prognostic parameter in prostate cancer (PCa). We analysed the detection of micrometastases (miN + ) in initially nodal-negative (pN0) radical prostatectomy specimens from pT2a-c and pT3a PCa patients by immunohistochemistry (IHC). Material and Methods A total of 2352 lymph nodes of 193 PCa patients were centrally re-examined for miN + or miN- status using IHC. Results were correlated with clinical and follow-up data. Recurrence-free survival (RFS) was calculated with the log-rank test using the Kaplan-Meier method. In addition, a logistic regression analysis was performed. Results IHC detected miN + in a total of 17 patients (8.8 %). miN + seemed to be significantly associated with a higher Gleason score and was detected in more advanced pT stages. A total of 45 patients (23.1 %) had a biochemical recurrence (BCR). BCR was associated with miN +. Patients with miN + had a significantly shorter RFS (22.9 versus 58.7 months; p < 0.001). In the univariate (OR: 5.04; 95 % CI: 2.46 – 10.6; p-value: < 0.0001) and multivariate (OR: 3.29; 95 % CI: 1.54 – 7.08; p-value: 0.002) regression model, the miN + status was the strongest predictor of a BCR. Conclusions IHC seems to be of high diagnostic value for the detection of micrometastases in initially nodal-negative PCa patients. IHC should therefore be performed in PCa patients with nodal-negative findings.

Publisher

Georg Thieme Verlag KG

Subject

Urology

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