Analysis Of "Negative" Lymph Nodes In Prostate Cancer Reveals Occult Metastasis In 13%

UroToday.com - Node positive prostate cancer (CaP) usually results in early androgen-deprivation therapy. The incidence of pathologic understaging of surgical lymph nodes in CaP is unknown. Dr. Pagliarulo and associates from the University of Southern California report an analysis of occult positive lymph nodes in node-negative (N0) specimens in the June 20, 2006 issue of the Journal of Clinical Oncology.

Between 1983 and 1991 180 patients with stage pT3N0 CaP who underwent radical prostatectomy and pelvic lymphadenectomy and who had sufficient tissue for analysis were compared to 94 patients with N+ disease. Tissue from N0 patients was stained for cytokeratins AE-1 and CAM5.2, and if positive was further stained with PSA antibody. Median clinical follow-up ranged from 12-14 years and included PSA levels, clinical progression and survival data. N0 patients with no evidence of occult metastases after staining were classified as occult lymph node negative (OLN-) and those whose tissue stained positive were classified as occult lymph node positive (OLN+).

Patient characteristics demonstrated Gleason score 7-10 disease in 65%, positive margins and seminal vesicle involvement in over half and adjuvant radiotherapy was given to 82%. Prostate cancer tumor cells were identified in 24 of 180 N0 patients for an OLN+ rate of 13.3%. On average, 143 CaP cells were found per positive lymph node.

While pathologic stage, Gleason score and positive surgical margins were all higher in N+ patients compared with N0 patients, OLN+ patients were more likely to have stage pT3b disease than OLN- patients. At 10 years, the estimated probability of developing recurrence was 0.36, 0.61 and 0.69 for patients with OLN-, OLN+ and N+ disease, respectively. Men with OLN+ disease were 2.27 times as likely to develop recurrence as OLN- men. OLN+ patients were 2.07 times as likely as OLN- patients to die at 10 years. In a Cox regression model, only Gleason score and lymph node status remained significantly associated with overall survival.

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By Christopher P. Evans, M.D.

J Clin Oncol 2006;24:2735-42
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