Marked Prognostic Impact of Minimal Lymphatic Tumor Spread in Prostate Cancer
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Marked Prognostic Impact of Minimal Lymphatic Tumor Spread in Prostate Cancer. / Wilczak, Waldemar; Wittmer, Corinna; Clauditz, Till; Minner, Sarah; Steurer, Stefan; Büscheck, Franziska; Krech, Till; Lennartz, Maximilian; Harms, Luisa; Leleu, Diane; Ahrens, Marc; Ingwerth, Sebastian; Günther, Christian T; Koop, Christina; Simon, Ronald; Jacobsen, Frank; Tsourlakis, Maria C; Chirico, Viktoria; Höflmayer, Doris; Vettorazzi, Eik; Haese, Alexander; Steuber, Thomas; Salomon, Georg; Michl, Uwe; Budäus, Lars; Tilki, Derya; Thederan, Imke; Fraune, Christoph; Göbel, Cosima; Henrich, Marie-Christine; Juhnke, Manuela; Möller, Katharina; Bawahab, Ahmed Abdullah; Uhlig, Ria; Adam, Meike; Weidemann, Sören; Beyer, Burkhard; Huland, Hartwig; Graefen, Markus; Sauter, Guido; Schlomm, Thorsten.
in: EUR UROL, Jahrgang 74, Nr. 3, 09.2018, S. 376-386.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Marked Prognostic Impact of Minimal Lymphatic Tumor Spread in Prostate Cancer
AU - Wilczak, Waldemar
AU - Wittmer, Corinna
AU - Clauditz, Till
AU - Minner, Sarah
AU - Steurer, Stefan
AU - Büscheck, Franziska
AU - Krech, Till
AU - Lennartz, Maximilian
AU - Harms, Luisa
AU - Leleu, Diane
AU - Ahrens, Marc
AU - Ingwerth, Sebastian
AU - Günther, Christian T
AU - Koop, Christina
AU - Simon, Ronald
AU - Jacobsen, Frank
AU - Tsourlakis, Maria C
AU - Chirico, Viktoria
AU - Höflmayer, Doris
AU - Vettorazzi, Eik
AU - Haese, Alexander
AU - Steuber, Thomas
AU - Salomon, Georg
AU - Michl, Uwe
AU - Budäus, Lars
AU - Tilki, Derya
AU - Thederan, Imke
AU - Fraune, Christoph
AU - Göbel, Cosima
AU - Henrich, Marie-Christine
AU - Juhnke, Manuela
AU - Möller, Katharina
AU - Bawahab, Ahmed Abdullah
AU - Uhlig, Ria
AU - Adam, Meike
AU - Weidemann, Sören
AU - Beyer, Burkhard
AU - Huland, Hartwig
AU - Graefen, Markus
AU - Sauter, Guido
AU - Schlomm, Thorsten
N1 - Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2018/9
Y1 - 2018/9
N2 - BACKGROUND: Nodal metastasis (N1) is a strong prognostic parameter in prostate cancer; however, lymph node evaluation is always incomplete.OBJECTIVE: To study the prognostic value of lymphatic invasion (L1) and whether it might complement or even replace lymph node analysis in clinical practice.DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of pathological and clinical data from 14 528 consecutive patients.INTERVENTION: Radical prostatectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The impact of L1 and N1 on patient prognosis was measured with time to biochemical recurrence as the primary endpoint.RESULTS AND LIMITATIONS: Nodal metastases were found in 1602 (12%) of 13 070 patients with lymph node dissection. L1 was seen in 2027 of 14 528 patients (14%) for whom lymphatic vessels had been visualized by immunohistochemistry. N1 and L1 continuously increased with unfavorable Gleason grade, advanced pT stage, and preoperative prostate-specific antigen (PSA) values (p<0.0001 each). N1 was found in 4.3% of 12 501 L0 and in 41% of 2027 L1 carcinomas (p<0.0001). L1 was seen in 11% of 9868 N0 and in 61% of 1360 N1 carcinomas (p<0.0001). Both N1 and L1 were linked to PSA recurrence (p<0.0001 each). This was also true for 17 patients with isolated tumor cells (ie, <200 unequivocal cancer cells without invasive growth) and 193 metastases ≤1mm. Combined analysis of N and L status showed that L1 had no prognostic effect in N1 patients but L1 was strikingly linked to PSA recurrence in N0 patients. N0L1 patients showed a similar outcome as N1 patients.CONCLUSIONS: Analysis of lymphatic invasion provides comparable prognostic information than lymph node analysis. Even minimal involvement of the lymphatic system has pivotal prognostic impact in prostate cancer. Thus, a thorough search for lymphatic involvement helps to identify more patients with an increased risk for disease recurrence.PATIENT SUMMARY: Already minimal amounts of tumor cells inside the lymph nodes or intraprostatic lymphatic vessels have a severe impact on patient prognosis.
AB - BACKGROUND: Nodal metastasis (N1) is a strong prognostic parameter in prostate cancer; however, lymph node evaluation is always incomplete.OBJECTIVE: To study the prognostic value of lymphatic invasion (L1) and whether it might complement or even replace lymph node analysis in clinical practice.DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of pathological and clinical data from 14 528 consecutive patients.INTERVENTION: Radical prostatectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The impact of L1 and N1 on patient prognosis was measured with time to biochemical recurrence as the primary endpoint.RESULTS AND LIMITATIONS: Nodal metastases were found in 1602 (12%) of 13 070 patients with lymph node dissection. L1 was seen in 2027 of 14 528 patients (14%) for whom lymphatic vessels had been visualized by immunohistochemistry. N1 and L1 continuously increased with unfavorable Gleason grade, advanced pT stage, and preoperative prostate-specific antigen (PSA) values (p<0.0001 each). N1 was found in 4.3% of 12 501 L0 and in 41% of 2027 L1 carcinomas (p<0.0001). L1 was seen in 11% of 9868 N0 and in 61% of 1360 N1 carcinomas (p<0.0001). Both N1 and L1 were linked to PSA recurrence (p<0.0001 each). This was also true for 17 patients with isolated tumor cells (ie, <200 unequivocal cancer cells without invasive growth) and 193 metastases ≤1mm. Combined analysis of N and L status showed that L1 had no prognostic effect in N1 patients but L1 was strikingly linked to PSA recurrence in N0 patients. N0L1 patients showed a similar outcome as N1 patients.CONCLUSIONS: Analysis of lymphatic invasion provides comparable prognostic information than lymph node analysis. Even minimal involvement of the lymphatic system has pivotal prognostic impact in prostate cancer. Thus, a thorough search for lymphatic involvement helps to identify more patients with an increased risk for disease recurrence.PATIENT SUMMARY: Already minimal amounts of tumor cells inside the lymph nodes or intraprostatic lymphatic vessels have a severe impact on patient prognosis.
KW - Journal Article
U2 - 10.1016/j.eururo.2018.05.034
DO - 10.1016/j.eururo.2018.05.034
M3 - SCORING: Journal article
C2 - 29908878
VL - 74
SP - 376
EP - 386
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 3
ER -