학술논문
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: Real‐world data analysis from a Japanese cohort.
Document Type
Article
Author
Kato, Masashi; Shiota, Masaki; Kimura, Takahiro; Hanazawa, Ryoichi; Hirakawa, Akihiro; Takamatsu, Dai; Tashiro, Kojiro; Matsui, Yoshiyuki; Hashine, Katsuyoshi; Saito, Ryoichi; Yokomizo, Akira; Yamamoto, Yoshiyuki; Narita, Shintaro; Hashimoto, Kohei; Matsumoto, Hiroaki; Akamatsu, Shusuke; Nishiyama, Naotaka; Eto, Masatoshi; Kitamura, Hiroshi; Tsuzuki, Toyonori
Source
Subject
Language
ISSN
0919-8172
Abstract
Objectives Methods Results Conclusions 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).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).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.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. [ABSTRACT FROM AUTHOR]