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Relative impact of lymph-node metastasis and seminal vesical invasion on oncologic outcomes following radical prostatectomy

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

While both seminal vesicle (SVI) and lymph-node invasion (LNI) have been identified as adverse prognostic variables among men undergoing radical prostatectomy (RP), the relative impact of each of these features on subsequent oncologic outcomes has not been well defined. We assessed the impact of LNI on long-term oncologic outcomes among patients with SVI at RP.

Methods

We reviewed 19,519 patients who underwent RP and identified 2043 with SVI. Metastasis-free (MFS), cancer-specific (CSS), and overall survival (OS) were estimated for patients with SVI, stratified by the presence and number of pelvic lymph node metastases. Cox proportional hazards models were used to evaluate the independent association of the number of metastatic nodes and lymph node density with oncologic outcomes among patients with SVI, controlling for age, year of surgery, margin status, preoperative PSA, pathologic Gleason score, extraprostatic extension, and use of adjuvant therapies.

Results

At a median follow up of 12.1 years (IQR 7.0,18.6), 548 patients developed metastatic disease and 1331 died, including 406 who died from prostate cancer (PCa). We found that, among patients with SVI, the presence of a single positive lymph node was not associated with incrementally adverse oncologic outcomes compared to no nodal metastasis at RP, with 10-year MFS, CSS, and OS rates of 81.3% versus 78.3%(p = 0.18), 86.5% versus 89.8%(p = 0.32), and 72.8% versus 76.7%(p = 0.53), respectively. In contrast, on multivariable analyses, the presence of ≥2 metastatic nodes and a 20% lymph-node density cut off remained independently associated with worse survival.

Conclusions

SVI represents an adverse pathologic feature such that the presence of a single positive pelvic lymph node did not further adversely impact prognosis. Meanwhile, a significant number of involved nodes was associated with decreased survival. These findings may aid in risk-stratification as well as clinical trial design for such high-risk patients following surgery.

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Fig. 1: Kaplan–Meier estimates of MFS, CSS, and OS after radical prostatectomy, stratified by the presence of seminal vesicle invasion.
Fig. 2: Kaplan–Meier estimates of MFS, CSS, and OS after radical prostatectomy among patients with SVI, stratified by the number of positive pelvic lymph nodes.
Fig. 3: Kaplan–Meier estimates of MFS, CSS, and OS after radical prostatectomy among patients with SVI and negative nodes compared to patients with a single positive pelvic node without SVI.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Author information

Authors and Affiliations

  1. Mayo Clinic, Department of Urology, Rochester, MN, USA

    Rodrigo Rodrigues Pessoa, Reza Nabavizadeh, Paras Shah, Igor Frank, Mathew Tollefson, Vidit Sharma, R. Jeffrey Karnes & Stephen A. Boorjian

  2. Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, USA

    Laureano J. Rangel

  3. Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA

    John C. Cheville

Authors
  1. Rodrigo Rodrigues Pessoa
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Contributions

Protocol / project development: RRP, RN, SB. Data collection or management: LJ. Data analysis: LJR. Manuscript writing / editing: RRP, RN, SB. Other (Interpretation of data and revision): PS, IF, MT, VS, JCC, RJK, and SAB.

Corresponding author

Correspondence to Stephen A. Boorjian.

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Competing interests

The authors declare no competing interests.

Ethics approval

Institutional review board approval IRB: 22-009986. The study was performed in accordance with the Declaration of Helsinki.

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Supplementary information

41391_2023_724_MOESM1_ESM.docx

Supplementary table: Multivariable Cox regression analyses for metastasis-free survival, cancer-specific survival, and overall survival in 1,241 patients with prostate cancer with concomitant seminal

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Rodrigues Pessoa, R., Nabavizadeh, R., Shah, P. et al. Relative impact of lymph-node metastasis and seminal vesical invasion on oncologic outcomes following radical prostatectomy. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00724-9

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