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Significance of examined lymph-node count in accurate staging and long-term survival in patients undergoing radical prostatectomy: a population-based study

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Abstract

Purpose

The number of examined lymph node (ELN) is regarded as the critical quality index for cancer care. We scrutinize the relationship among ELN number, accurate staging, and long-term survival in prostate cancer (Pca).

Methods

Population-based data on Pca patients in 2004–2015 from the US SEER database were investigated. The connection among ELN number and stage migration, overall survival (OS), and prostate cancer-specific survival (CSS) were evaluated by performing multivariable-adjusted logistic, Cox proportional hazards, and fine-gray competing-risk regression models, respectively. LOWESS smoother was used to fit the series of ELN number, odds ratios (OR), and hazard ratios (HR), while the Chow test was used to resolve the structural breakpoints. Subgroup and interaction analyses were performed in different risk populations.

Results

Overall, 84,838 patients were analyzed. Serial improvements were seen in stage migration (OR, 1.072, P < 0.001), OS (HR, 0.991; P < 0.001), and CSS (HR, 0.983; P < 0.001) per additional ELN after adjusting for confounders. Subgroup analysis revealed that the ELN number gains the most staging and survival benefits in high-risk population (P for interaction < 0.001). Cut-point analyses suggested that an optimal number of 12 ELNs, which was verified by the cumulative incidence curve, had a strong capability to distinguish different probabilities of CSS.

Conclusions

Higher quantities of ELNs are related to more-accurate nodal staging and long-term survival of Pca patients undergoing RP. We highlight that 12 ELNs are the optimal cut-point for the high-risk population to investigate the quality of LN detection and stratifying postoperative prognosis.

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Abbreviations

ELN:

Examined lymph node

LN:

Lymph node

PCa:

Prostate cancer

PLND:

Pelvic lymph-node dissection

LND:

Lymph-node dissection

LNI:

Lymph-node involvement

RP:

Radical prostatectomy

PSA:

Prostate-specific antigen

SEER:

Surveillance, epidemiology, and end results database

LOWESS:

the locally weighted scatterplot smoothing

NCCN:

the National Comprehensive Cancer Network

OR:

Odds ratio

HR:

Hazard ratio

LL:

Lower limit of 95% CI

UL:

Upper limit of 95% CI

Sig.:

Significance

IQR:

Interquartile range

OS:

Overall survival

CSS:

Prostate cancer-specific survival

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Drafting the manuscript, Cheng Chen, Jie Shen, and Zhaoyu Xing; Revising, Changchuan Jiang and Li Cui; Conception and design, Xiaozhou He and Renfang Xu; Acquisition of data, Cheng Chen; Analysis and interpretation of data, Dong Xue and Linkun Hu.

Correspondence to Renfang Xu.

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Chen, C., Shen, J., Xing, Z. et al. Significance of examined lymph-node count in accurate staging and long-term survival in patients undergoing radical prostatectomy: a population-based study. Int Urol Nephrol 52, 271–278 (2020). https://doi.org/10.1007/s11255-019-02300-4

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Keywords

  • Prostatic neoplasms
  • SEER program
  • Lymph-node dissection
  • Radical prostatectomy
  • Prognosis
  • Cheng Chen