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Concurrent prognostic utility of lymph node count and lymph node density for men with pathological node-positive prostate cancer

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

While both the number (+LN) and density (LND) of metastatic lymph nodes on radical prostatectomy lymphadenectomy predict mortality in prostate cancer, the independent impact of each on overall mortality (OM) is unknown.

Methods

We sampled men who underwent radical prostatectomy and lymphadenectomy between 2004 and 2013 from the National Cancer Database. Multivariable Cox proportional hazards analysis with restricted cubic spline was used to assess the non-linear association of +LN count and LND with OM.

Results

Of 229,547 men in our sample, 3% (n = 7507) had +LNs, of which 89% had 1-3 +LN and 11% had ≥4 +LN. In multivariable Cox analysis across all patients, OM increased with each additional +LN up to four (HR 1.14, 95%CI 1.06–1.23 per node), with no increase beyond 4 +LN. LND was an independent predictor of OM (HR 1.09, 95%CI 1.06–1.12 per 10% increase). However, after excluding patients with inadequate nodal sampling (<5 LN examined), the variation in OM explained by LND was negligible for patients with ≤3 +LN. In men with 1, 2, and 3 +LN, there was a 0.28%, 0.02%, and 0.50% increase in OM for each 10% increase in LND, compared with 1.9% and 1.6% for men with 4 or 5+ LNs.

Conclusions

While +LN count and LND independently predict OM, the impact of LND is negligible in men with ≤3 +LN, who comprise the vast majority of men with +LN. Pathological nodal staging should primarily rely on LN count rather than LND.

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Fig. 1: Overall mortality at 96 months by lymph node density within subgroups of metastatic lymph node count (1–4 positive lymph nodes) on radical prostatectomy lymphadenectomy.
Fig. 2: Overall mortality at 96 months by lymph node density within subgroups of metastatic lymph node count on radical prostatectomy with lymphadenectomy.
Fig. 3: Overall mortality at 96 months by lymph node density among patients with 5+ nodes examined on radical prostatectomy with lymphadenectomy.

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Authors and Affiliations

  1. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    John M. Masterson, Michael Luu, Aurash Naser-Tavakolian, Stephen J. Freedland & Timothy J. Daskivich

  2. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Michael Luu, Howard Sandler, Zachary S. Zumsteg & Timothy J. Daskivich

  3. Section of Urology, Durham VA Medical Center, Durham, NC, USA

    Stephen J. Freedland

  4. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Howard Sandler & Zachary S. Zumsteg

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  1. John M. Masterson
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  7. Timothy J. Daskivich
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Contributions

JM—Writing - Original Draft, Investigation, Formal analysis. ML—Software, Formal analysis, Data Curation, Visualization. AN—Writing - Review & Editing, Investigation. SF—Writing - Review & Editing, Supervision. HS—Writing - Review & Editing, Supervision. ZZ—Writing - Review & Editing, Supervision. TD—Conceptualization, Methodology, Validation, Investigation, Resources, Writing - Review & Editing, Supervision.

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Correspondence to Timothy J. Daskivich.

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Masterson, J.M., Luu, M., Naser-Tavakolian, A. et al. Concurrent prognostic utility of lymph node count and lymph node density for men with pathological node-positive prostate cancer. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-022-00635-1

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