Long-term Outcomes of Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer: Results of a Single-institution Series with a Minimum Follow-up of 5 Years
Menée sur 59 patients atteints d'un cancer de la prostate avec récidive biochimique après prostatectomie radicale (durée médiane de suivi : 81,1 mois), cette étude évalue, du point de vue du taux de réponse biochimique complète (PSA <0.2 ng/ml 40 jours après l'intervention chirurgicale) et du taux de survie sans récidive biochimique à 8 ans, l'efficacité d'un curage ganglionnaire de sauvetage
Background : Prostate cancer (PCa) patients with lymph node recurrence after radical prostatectomy (RP) are usually managed with androgen-deprivation therapy. Despite the absence of prospective randomized studies, salvage lymph node dissection (LND) has been proposed as an alternative treatment option. Objective : To examine long-term outcomes of salvage LND in patients with nodal recurrent PCa documented by 11C-choline positron emission tomography/computed tomography (PET/CT) scan. Design, setting, and participants : Overall, 59 patients affected by biochemical recurrence (BCR) with 11C-choline PET/CT scan with pathologic activity treated between 2002 and 2008 were included. Intervention : Pelvic and/or retroperitoneal salvage LND. Outcome measurements and statistical analyses : Biochemical response (BR) was defined as prostate-specific antigen (PSA) <0.2 ng/ml at 40 d after surgery. BCR for those who achieved BR was defined as a PSA >0.2 ng/ml. Clinical recurrence (CR) was defined as a positive PET/CT scan after salvage LND in the presence of a rising PSA. Kaplan-Meier curves assessed time to BCR, CR, and cancer-specific mortality (CSM). Cox regression analyses were fitted to assess predictors of CR. Results and limitations : Median follow-up after salvage LND was 81.1 mo. Overall, 35 patients (59.3%) achieved BR. The 8-yr BCR-free survival rate in patients with complete BR was 23%. Overall, the 8-yr CR- and CSM-free survival rates were 38% and 81%, respectively. In multivariable analyses evaluating preoperative variables, PSA at salvage LND represented the only predictor of CR (p=0.03). When postoperative variables were considered, BR and the presence of retroperitoneal lymph node metastases were significantly associated with the risk of CR (all p ≤ 0.04). Our study is limited by the lack of a control group. Conclusions : Salvage LND may represent a therapeutic option for patients with BCR after RP and nodal pathologic uptake at 11C-choline PET/CT scan. Although most patients progressed to BCR after salvage LND, roughly 40% of them experienced CR-free survival. Patient summary : Salvage lymph node dissection may represent a therapeutic option for selected patients with nodal recurrence after radical prostatectomy. Roughly 40% of men did not show any further clinical recurrence at long-term follow-up after surgery. Take Home Message : Salvage lymph node dissection might represent a treatment approach for selected patients with imaging-detected nodal recurrence after radical prostatectomy. Despite almost invariable biochemical progression, approximately 40% of patients did not show any further clinical recurrence at 8 yr after surgery. The best candidates for this approach seem to be those men with a low volume of recurrent nodal disease limited to the lymphatic pelvic areas.