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Purpose <p>Surgical features associated with better cancer-control outcomes are under investigation for salvage radical prostatectomy patients undergoing robotic approaches.</p> Methods <p>The Junior ERUS/Young Academic Urologist Working Group in Robotics in Urology conducted a multicentric project to investigate the effect of lymph node dissection (LND) and pN stage on biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival (OS) outcomes in 444 robotic salvage radical prostatectomy (s-RARP) patients.</p> Results <p>Of all patients, 63% underwent LND with a median of eight removed lymph nodes. Patients without LND more frequently underwent initial focal therapy (60% vs. 37%) and harbored higher pathological Gleason score 8–10 (both <i>p</i> ≤ 0.02). In BCR analyses, no differences were observed between patients with vs. without LND with 24-months BCR-free survival rates of 74.8% vs. 73.6%. In OS analyses, better OS for LND patients (HR: 0,39, <i>p</i> = 0.049) was observed with 60-months OS rates of 81.3% vs. 92.1% for no LND vs. LND. Of LND patients. 16% harbored pN1 stage, which was associated with worse BCR-free survival (HR: 2.0,<i>p</i> = 0.025) with 60-months BCR-free survival rates of 63% for pN0 vs. 49.6% for pN1. In MFS analyses, no difference between both groups were observed. In OS analyses, the observed differences did not reach statistical significance with 60-months OS rates of 93.4% for pN0 vs. 84.7% for pN1.</p> Conclusion <p>Rates of LND are relatively low in contemporary s-RARP patients and are more frequently performed in patients with worse characteristics. However, LND may be associated with better OS, while pN1 patients are associated with worse cancer-control outcomes.</p>

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The effect of lymph node dissection on oncological outcomes in contemporary robotic salvage radical prostatectomy patients: a junior ERUS/YAU collaborative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月9日

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  • Mike Wenzel,
  • Christoph Würnschimmel,
  • Marcio Covas Moschovas,
  • Arjun Nathan,
  • Christian Wagner,
  • Giorgio Calleris,
  • Fabrizio Di Maida,
  • Juan Gomez Rivas,
  • Carlo Andrea Bravi,
  • Ruben De Groote,
  • Federico Piramide,
  • Filippo Turri,
  • Keith Kowalczyk,
  • Gopal Sharma,
  • Iulia Andras,
  • Edward Lambert,
  • Nikolaos Liakos,
  • Danny Darlington,
  • Marco Paciotti,
  • Gabriele Sorce,
  • Philipp Mandel,
  • Antonio Galfano,
  • Giancarlo Marra,
  • Senthil Nathan,
  • Paolo Dell’Oglio,
  • Alexandre Mottrie,
  • Felix K. H. Chun,
  • Vipul Patel,
  • Alberto Breda,
  • Alessandro Larcher

摘要

Purpose

Surgical features associated with better cancer-control outcomes are under investigation for salvage radical prostatectomy patients undergoing robotic approaches.

Methods

The Junior ERUS/Young Academic Urologist Working Group in Robotics in Urology conducted a multicentric project to investigate the effect of lymph node dissection (LND) and pN stage on biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival (OS) outcomes in 444 robotic salvage radical prostatectomy (s-RARP) patients.

Results

Of all patients, 63% underwent LND with a median of eight removed lymph nodes. Patients without LND more frequently underwent initial focal therapy (60% vs. 37%) and harbored higher pathological Gleason score 8–10 (both p ≤ 0.02). In BCR analyses, no differences were observed between patients with vs. without LND with 24-months BCR-free survival rates of 74.8% vs. 73.6%. In OS analyses, better OS for LND patients (HR: 0,39, p = 0.049) was observed with 60-months OS rates of 81.3% vs. 92.1% for no LND vs. LND. Of LND patients. 16% harbored pN1 stage, which was associated with worse BCR-free survival (HR: 2.0,p = 0.025) with 60-months BCR-free survival rates of 63% for pN0 vs. 49.6% for pN1. In MFS analyses, no difference between both groups were observed. In OS analyses, the observed differences did not reach statistical significance with 60-months OS rates of 93.4% for pN0 vs. 84.7% for pN1.

Conclusion

Rates of LND are relatively low in contemporary s-RARP patients and are more frequently performed in patients with worse characteristics. However, LND may be associated with better OS, while pN1 patients are associated with worse cancer-control outcomes.