New findings suggest that extensive lymph node dissection (LND) during radical prostatectomy (RP) for prostate cancer may not offer therapeutic benefits, investigators reported at the ASCO Genitourinary Cancers Symposium 2022.
Emily Chan, MD, PhD, of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco, and colleagues looked at the impact of LND extent at RP on outcomes among participants in the randomized controlled NRG/RTOG 9601 clinical trial. The trial included men with pT2/T3 cancer who underwent radiation therapy (RT) alone or RT plus antiandrogen therapy (bicalutamide) for elevated PSA following RP.
Dr Chan’s team studied 552 (73%) patients who had complete data available. Each arm had 276 patients. The treatment arms did not differ significantly in patient demographics or clinical characteristics, including median total lymph nodes removed (5 in the RT alone arm and 6 in the combination therapy arm).
In both arms combined and each arm separately, the investigators found no significant association between overall and disease-specific survival and total lymph nodes removed.
On multivariable analysis, Gleason score was the only factor associated with worse overall and disease-specific survival, and this was only in the RT alone arm.
A previous study published in European Urology in 2018 demonstrated that a higher number of lymph nodes removed at radical prostatectomy was associated with improved outcomes among men receiving salvage radiation for elevated PSA after surgery. The higher the number of lymph nodes removed, the lower the risk for biochemical and clinical recurrence after salvage therapy.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Chan E, Pugh SL, Simko J, et al. Impact of lymph node yield at prostatectomy on outcomes in NRT-RTOG 9601. Presented at ASCO GU 2022; February 17-19, 2022. Abstract 265.