Cancer volume of lymph node metastasis predicts progression in prostate cancer

Liang Cheng, Erik J. Bergstralh, John C. Cheville, Jeff Slezak, Federico A. Corica, Horst Zincke, Michael L. Blute, David G. Bostwick

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

Clinical outcome is variable in prostate cancer patients with regional lymph node metastasis. We studied 269 patients who had regional lymph node metastasis at the time of radical retropubic prostatectomy and bilateral pelvic lymphadenectomy at the Mayo Clinic between January 1987 and December 1992. Two hundred fifty-three (94%) patients received androgen deprivation therapy within 90 days of radical prostatectomy. Patients ranged in age from 47 to 79 years (median, 67 years). Median follow-up was 6.1 years (range, 0.3-10.5 years). Nodal cancer volume (size) was measured by the grid- counting method. Cox proportional hazards models were used to determine the impact of numerous clinical and pathologic findings on systemic progression- free survival. Systemic progression was defined as the presence of distant metastasis documented by biopsies or radiographic examinations (abdominal computerized tomography, plain radiographs, or bone scan). Five-year progression-free survival was 90%. In predicting systemic progression using Cox multivariate analysis, only nodal cancer volume added significantly to the model containing the primary cancer variables (Gleason score, cancer volume, and DNA ploidy). The relative hazard rate for a doubling in nodal cancer volume was 1.6 (95% confidence interval, 1.3 to 2.0; p <0.0001). Spearman rank analysis showed a correlation between nodal cancer volume and Gleason score of the primary cancer, the number of positive nodes, the aggregate length of metastases, and the largest nodal cancer diameter (correlation efficient = 0.37, 0.63, 0.96, and 0.95, respectively). Our data indicate that nodal cancer volume was the most significant nodal determinant of progression to distant metastasis in lymph node-positive prostate cancer patients. We recommend that the diameter of the largest metastasis be evaluated in patients with metastases, because this is a more powerful predictor of patient outcome than current methods, which recommend mere counting of the number of positive nodes.

Original languageEnglish (US)
Pages (from-to)1491-1500
Number of pages10
JournalAmerican Journal of Surgical Pathology
Volume22
Issue number12
DOIs
StatePublished - Dec 1998

Fingerprint

Prostatic Neoplasms
Lymph Nodes
Neoplasm Metastasis
Neoplasms
Neoplasm Grading
Prostatectomy
Disease-Free Survival
Ploidies
Lymph Node Excision
Proportional Hazards Models
Androgens
Multivariate Analysis
Tomography
Confidence Intervals
Biopsy
Bone and Bones
DNA

Keywords

  • Cancer volume
  • Metastasis
  • Progression
  • Prostate
  • Size

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Cheng, L., Bergstralh, E. J., Cheville, J. C., Slezak, J., Corica, F. A., Zincke, H., ... Bostwick, D. G. (1998). Cancer volume of lymph node metastasis predicts progression in prostate cancer. American Journal of Surgical Pathology, 22(12), 1491-1500. https://doi.org/10.1097/00000478-199812000-00006

Cancer volume of lymph node metastasis predicts progression in prostate cancer. / Cheng, Liang; Bergstralh, Erik J.; Cheville, John C.; Slezak, Jeff; Corica, Federico A.; Zincke, Horst; Blute, Michael L.; Bostwick, David G.

In: American Journal of Surgical Pathology, Vol. 22, No. 12, 12.1998, p. 1491-1500.

Research output: Contribution to journalArticle

Cheng, L, Bergstralh, EJ, Cheville, JC, Slezak, J, Corica, FA, Zincke, H, Blute, ML & Bostwick, DG 1998, 'Cancer volume of lymph node metastasis predicts progression in prostate cancer', American Journal of Surgical Pathology, vol. 22, no. 12, pp. 1491-1500. https://doi.org/10.1097/00000478-199812000-00006
Cheng, Liang ; Bergstralh, Erik J. ; Cheville, John C. ; Slezak, Jeff ; Corica, Federico A. ; Zincke, Horst ; Blute, Michael L. ; Bostwick, David G. / Cancer volume of lymph node metastasis predicts progression in prostate cancer. In: American Journal of Surgical Pathology. 1998 ; Vol. 22, No. 12. pp. 1491-1500.
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abstract = "Clinical outcome is variable in prostate cancer patients with regional lymph node metastasis. We studied 269 patients who had regional lymph node metastasis at the time of radical retropubic prostatectomy and bilateral pelvic lymphadenectomy at the Mayo Clinic between January 1987 and December 1992. Two hundred fifty-three (94{\%}) patients received androgen deprivation therapy within 90 days of radical prostatectomy. Patients ranged in age from 47 to 79 years (median, 67 years). Median follow-up was 6.1 years (range, 0.3-10.5 years). Nodal cancer volume (size) was measured by the grid- counting method. Cox proportional hazards models were used to determine the impact of numerous clinical and pathologic findings on systemic progression- free survival. Systemic progression was defined as the presence of distant metastasis documented by biopsies or radiographic examinations (abdominal computerized tomography, plain radiographs, or bone scan). Five-year progression-free survival was 90{\%}. In predicting systemic progression using Cox multivariate analysis, only nodal cancer volume added significantly to the model containing the primary cancer variables (Gleason score, cancer volume, and DNA ploidy). The relative hazard rate for a doubling in nodal cancer volume was 1.6 (95{\%} confidence interval, 1.3 to 2.0; p <0.0001). Spearman rank analysis showed a correlation between nodal cancer volume and Gleason score of the primary cancer, the number of positive nodes, the aggregate length of metastases, and the largest nodal cancer diameter (correlation efficient = 0.37, 0.63, 0.96, and 0.95, respectively). Our data indicate that nodal cancer volume was the most significant nodal determinant of progression to distant metastasis in lymph node-positive prostate cancer patients. We recommend that the diameter of the largest metastasis be evaluated in patients with metastases, because this is a more powerful predictor of patient outcome than current methods, which recommend mere counting of the number of positive nodes.",
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