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

Andreas Maxeiner; Andreas Grevendieck; Therese Pross; Marc Rudl; Alexander Arnold; Carsten Stephan; Klaus Jung; Kurt Miller; Ergin Kilic; Jonas Busch

doi:10.1055/a-0856-6545

Aktuelle Urol 2019; 50(06): 612-618
DOI: 10.1055/a-0856-6545

Original Article

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

Lymphatische Mikrometastasen prognostizieren ein biochemisches Rezidiv in Patienten nach radikaler Prostatektomie und pelviner Lymphadenektomie

Authors

Andreas Maxeiner

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

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

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

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

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

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

³Berlin Institute for Urologic Research, Berlin
Klaus Jung

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

³Berlin Institute for Urologic Research, Berlin
Kurt Miller

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

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

⁴Institute of Pathology, Klinikum Leverkusen, Leverkusen
Jonas Busch^*

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

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.

Zusammenfassung

Hintergrund Lymphknotenmetastasen sind ein wichtiger prognostischer Parameter im Rahmen eines Prostatakarzinoms (PCa). Innerhalb einer Kohorte von Prostatektomie-Patienten mit pT2a-c- und pT3a-Tumoren und initial postoperativ nodal negativem (pN0) Status wurde die Detektion von Mikrometastasen (miN + ) mittels Immunhistochemie (IHC) ermittelt.

Material und Methoden Retrospektiv wurden 2352 Lymphknoten von 193 Patienten zentral auf das Vorliegen eines miN + Status untersucht. Die Ergebnisse wurden mit klinischen und postoperativen Verlaufsparametern korreliert. Das Rezidiv-freie-Überleben (RFS) wurde mittels Log-rank-Test und Kaplan-Meier-Methode ermittelt. Ferner wurde eine logistische Regression durchgeführt.

Ergebnisse IHC detektierte miN + in insgesamt 17 (8,8 %) Patienten. Eine signifikante Assoziation von miN + zeigte sich mit höheren Gleason-Scores als auch fortgeschrittenen Tumorstadien. Insgesamt hatten 45 (23,1 %) Patienten ein biochemisches Rezidiv (BCR). Das Vorliegen eines BCR war ebenfalls mit dem miN + assoziiert: miN + Patienten wiesen ein signifikant kürzeres RFS (22,9 versus 58,7 Monate; p < 0,001) auf. In der Regressionsanalyse zeigte sich sowohl univariat (OR: 5,04; 95 % CI: 2.46 – 10,6; p-value: < 0.0001) als auch multivariat der miN + Status als stärkster Prädiktor für ein BCR.

Schlussfolgerung IHC scheint von hohem diagnostischen Wert in der Detektion von Mikrometastasen in initial nodal negativen PCa-Patienten zu sein. Daher sollte die Option einer IHC stets in Patienten mit nodal negativem Befund evaluiert werden.

Keywords

micrometastases - pelvic lymph node dissection - radical prostatectomy - prostate cancer

Schlüsselwörter

Prostatakrebs - Mikrometastasen - Radikale Prostatektomie - Pelvine Lymphadenektomie

Full Text

References

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