Molecular Lymph Node Status for Prognostic Stratification of Prostate Cancer Patients Undergoing Radical Prostatectomy with Extended Pelvic Lymph Node Dissection
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Molecular Lymph Node Status for Prognostic Stratification of Prostate Cancer Patients Undergoing Radical Prostatectomy with Extended Pelvic Lymph Node Dissection. / Heck, Matthias M; Retz, Margitta; Bandur, Miriam; Souchay, Marc; Vitzthum, Elisabeth; Weirich, Gregor; Schuster, Tibor; Autenrieth, Michael; Kübler, Hubert; Maurer, Tobias; Thalgott, Mark; Herkommer, Kathleen; Gschwend, Jürgen E; Nawroth, Roman.
in: CLIN CANCER RES, Jahrgang 24, Nr. 10, 15.05.2018, S. 2342-2349.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung
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TY - JOUR
T1 - Molecular Lymph Node Status for Prognostic Stratification of Prostate Cancer Patients Undergoing Radical Prostatectomy with Extended Pelvic Lymph Node Dissection
AU - Heck, Matthias M
AU - Retz, Margitta
AU - Bandur, Miriam
AU - Souchay, Marc
AU - Vitzthum, Elisabeth
AU - Weirich, Gregor
AU - Schuster, Tibor
AU - Autenrieth, Michael
AU - Kübler, Hubert
AU - Maurer, Tobias
AU - Thalgott, Mark
AU - Herkommer, Kathleen
AU - Gschwend, Jürgen E
AU - Nawroth, Roman
N1 - ©2018 American Association for Cancer Research.
PY - 2018/5/15
Y1 - 2018/5/15
N2 - Purpose: Molecular lymph node (LN) analysis using quantitative polymerase chain reaction (qPCR) detects LN metastases with higher sensitivity than histopathology. However, the prognostic role of molecular LN status in prostate cancer patients treated with radical prostatectomy (RP) and extended pelvic LN dissection (ePLND) is unclear. To investigate the association of molecular compared with histopathologic LN status with biochemical recurrence.Experimental Design: Patients with intermediate and high-risk prostate cancer were prospectively enrolled and underwent RP with ePLND, including the obturator, internal, external, and the common iliac region. LNs ≥3 mm were bisected and examined by standard histopathology and qPCR for Kallikrein3 (KLK3) expression. Biochemical recurrence was defined by confirmed postoperative PSA > 0.2 ng/mL.Results: In 111 patients, 2,411 of 3,173 removed LNs were examined by both methods. Histopathology detected 68 LN metastases in 28 (25%) patients. Molecular analysis confirmed elevated KLK3 expression in 65 histopathologic LN metastases of all 28 pN1 patients (pN1/molN1) and additionally reclassified 224 histopathologic negative LNs and 32 (29%) pN0 patients as LN-positive (pN0/molN1).At a median follow-up of 48 months, 52 (47%) patients developed biochemical recurrence. Median biochemical recurrence-free survival was 9 months [95% confidence interval (CI), 0.0-20.1] in pN1/molN1 patients, 24 months (95% CI, 1.7-46.3) in pN0/molN1 patients and was not reached in pN0/molN0 patients (P < 0.001). On multivariable Cox regression analysis, molecular LN status [HR 4.1 (95% CI, 1.9-8.8), P < 0.001] but not histopathologic LN status [HR 1.5 (95% CI, 0.8-3.0), P = 0.198] was confirmed as independent predictor of biochemical recurrence.Conclusions: Molecular LN analysis identified pN0 patients with a high risk of biochemical recurrence and provided superior prognostic information in comparison with histopathology alone. Clin Cancer Res; 24(10); 2342-9. ©2018 AACR.
AB - Purpose: Molecular lymph node (LN) analysis using quantitative polymerase chain reaction (qPCR) detects LN metastases with higher sensitivity than histopathology. However, the prognostic role of molecular LN status in prostate cancer patients treated with radical prostatectomy (RP) and extended pelvic LN dissection (ePLND) is unclear. To investigate the association of molecular compared with histopathologic LN status with biochemical recurrence.Experimental Design: Patients with intermediate and high-risk prostate cancer were prospectively enrolled and underwent RP with ePLND, including the obturator, internal, external, and the common iliac region. LNs ≥3 mm were bisected and examined by standard histopathology and qPCR for Kallikrein3 (KLK3) expression. Biochemical recurrence was defined by confirmed postoperative PSA > 0.2 ng/mL.Results: In 111 patients, 2,411 of 3,173 removed LNs were examined by both methods. Histopathology detected 68 LN metastases in 28 (25%) patients. Molecular analysis confirmed elevated KLK3 expression in 65 histopathologic LN metastases of all 28 pN1 patients (pN1/molN1) and additionally reclassified 224 histopathologic negative LNs and 32 (29%) pN0 patients as LN-positive (pN0/molN1).At a median follow-up of 48 months, 52 (47%) patients developed biochemical recurrence. Median biochemical recurrence-free survival was 9 months [95% confidence interval (CI), 0.0-20.1] in pN1/molN1 patients, 24 months (95% CI, 1.7-46.3) in pN0/molN1 patients and was not reached in pN0/molN0 patients (P < 0.001). On multivariable Cox regression analysis, molecular LN status [HR 4.1 (95% CI, 1.9-8.8), P < 0.001] but not histopathologic LN status [HR 1.5 (95% CI, 0.8-3.0), P = 0.198] was confirmed as independent predictor of biochemical recurrence.Conclusions: Molecular LN analysis identified pN0 patients with a high risk of biochemical recurrence and provided superior prognostic information in comparison with histopathology alone. Clin Cancer Res; 24(10); 2342-9. ©2018 AACR.
KW - Journal Article
U2 - 10.1158/1078-0432.CCR-17-3771
DO - 10.1158/1078-0432.CCR-17-3771
M3 - SCORING: Journal article
C2 - 29463560
VL - 24
SP - 2342
EP - 2349
JO - CLIN CANCER RES
JF - CLIN CANCER RES
SN - 1078-0432
IS - 10
ER -
