Abstract
Introduction
Pelvic lymph node dissection (PLND) is not recommended for low-risk prostate cancer
(PCa) patients. However, the rate of PLND in this population is unknown.
Methods
We queried the National Cancer Data Base for PCa patients who underwent robot-assisted
radical prostatectomy from 2010 to 2013 and stratified them by D'Amico risk classification.
We identified the frequency of PLND in low-risk patients and identified factors associated
with receipt of PLND. Further, we determined the number of lymph nodes evaluated (quality)
and proportion of patients with detected nodal metastatic disease (utility) in each
risk group.
Results
Of 51,971 patients with low-risk PCa who underwent robot-assisted radical prostatectomy,
19,059 (36.7%) received PLND. Predictors of PLND in low-risk patients included rural
residence (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.009-1.327), treatment
at an academic center (OR, 1.492; 95% CI 1.188-1.874), and high-volume facility (OR,
1.327; 95% CI, 1.078-1.633). The mean number of lymph nodes obtained in low-risk patients
was lower than in intermediate/high-risk patients (4.74 vs. 5.86, P < .0001). Lymph node positivity was identified in 0.4% of low-risk patients and 4.6%
of intermediate/high-risk patients.
Conclusion
While PLND is not recommended for low-risk PCa by clinical practice guidelines, it
was performed frequently (36.7%) in a large hospital-based data set. PLND in this
population was of lower quality (nodal yield) and had less utility of detecting nodal
metastatic disease than PLND in intermediate/high-risk PCa. Treatment at a high-volume
or academic center was associated with increased use of PLND. Reasons for the variation
in practice patterns should be investigated to improve the value of PCa care.
Keywords
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References
- Cost implications and complications of overtreatment of low-risk prostate cancer in the United States.J Natl Compr Canc Netw. 2015; 13: 61-68
- Projections of the cost of cancer care in the United States, 2010-2020.J Natl Cancer Inst. 2011; 103: 117-128
- Cost of new technologies in prostate cancer treatment: systematic review of costs and cost effectiveness of robotic-assisted laparoscopic prostatectomy, intensity-modulated radiotherapy, and proton beam therapy [e-pub ahead of print].Eur Urol. 2017; https://doi.org/10.1016/j.eururo.2017.03.028
- Regional cost variations of robot-assisted radical prostatectomy compared with open radical prostatectomy.Clin Genitourin Cancer. 2015; 13: 447-452
- Cost per median overall survival month associated with abiraterone acetate and enzalutamide for treatment of patients with metastatic castration-resistant prostate cancer.J Med Econ. 2016; 19: 777-784
- Identifying drivers of episode cost variation with radical prostatectomy.Urology. 2016; 97: 105-110
- Temporal trends and the impact of race, insurance, and socioeconomic status in the management of localized prostate cancer.Eur Urol. 2017; 71: 729-737
- Prostate cancer. Version 3, 2016.(Available at:) (Accessed: April 15, 2017)
- Guideline for the management of clinically localized prostate cancer: 2007 update.J Urol. 2007; 177: 2106-2131
- EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent.Eur Urol. 2017; 71: 618-629
- Suboptimal use of pelvic lymph node dissection: differences in guideline adherence between robot-assisted and open radical prostatectomy.Can Urol Assoc J. 2016; 10: 269-276
- Risk of lymph node metastases in pathological Gleason score </= 6 prostate adenocarcinoma: analysis of institutional and population-based databases.Urol Oncol. 2017; 35: 31.e31-31.e36
- Patterns of pelvic lymph node dissection at the time of radical prostatectomy for low-risk men [e-pub ahead of print].Urology. 2017; https://doi.org/10.1016/j.urology.2017.01.037
- The association between total and positive lymph node counts, and disease progression in clinically localized prostate cancer.J Urol. 2006; 175: 1320-1324
- Does increasing the nodal yield improve outcomes in contemporary patients without nodal metastasis undergoing radical prostatectomy?.Urol Oncol. 2014; 32: 47.e41-47.e48
- Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer.Eur Urol. 2006; 50: 1006-1013
- Association between surgeon and hospital characteristics and lymph node counts from radical prostatectomy and pelvic lymph node dissection.Urology. 2015; 85: 890-895
- Overview of the Medicare physician fee schedule, 2017.(Available at:) (Accessed: April 15, 2017)
- Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?.Hum Pathol. 2017; 61: 190-198
- Differences in histopathological evaluation of standard lymph node dissections result in differences in nodal count but not in survival.World J Urol. 2013; 31: 1297-1302
Article info
Publication history
Published online: May 10, 2017
Accepted:
May 3,
2017
Received in revised form:
April 19,
2017
Received:
March 13,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
