Category: Laparoscopic/ Robotic: Prostate

MP15-19 - Risk stratification model for biochemical recurrence based on the number of positive lymph nodes and Gleason score after robot-assisted radical prostatectomy

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

We investigated the predictors for biochemical recurrence (BCR) after extended lymph node dissection followed by robot-assisted radical prostatectomy (RARP), and developed a prognostic factor-based risk stratification model.


Methods :

We analyzed the database of 410 patients who underwent RARP at our hospital between October 2010 and March 2018. 144 patients who received RARP with extended lymph node dissection and no neoadjuvant and immediate adjuvant therapy were included in this study. These patients were followed up for median of 24 (range: 6-75) months. BCR-free survival rate was determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of age, prostate-specific antigen, Gleason score, pathological results including the number of positive lymph nodes on BCR.


Results :

Median prostate-specific antigen was 9.11 (range: 2.4-39.2) ng/ml and median age was 68 (range: 49-76) years old. An average of 19.3 (range: 5-40) lymph nodes were removed per patient and 14 patients (9.7%) had positive lymph nodes. An average number of positive lymph nodes was 2.3 (range: 1-6) lymph nodes. In patients with 0 or 1 or ≥2 positive lymph nodes removed, BCR-free survival rate at 2 years were 93.8%, 71.4% and 28.6%, respectively (p<0.05). On multivariate analysis, Gleason score ≥8 (HR: 2.893; 95% CI: 1.023-8.180; p=0.045) and the presence of ≥2 positive lymph nodes (HR: 3.214; 95% CI: 1.799-5.739; p<0.001) were significant predictors of BCR. Patients were classified into three risk groups (poor risk groups: Gleason score ≥8 and 1 positive lymph node/ ≥2 positive lymph nodes, intermediate risk groups: Gleason score





Conclusions :

Patients who had ≥2 positive lymph nodes or 1 positive lymph node with Gleason score ≥8 detected after extended lymph node dissection followed by RARP had worse clinical courses. Immediate adjuvant hormone therapy should be considered for these patients after RARP.

Shuichi Morizane

Senior Lecturer
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

2001 M.D., Tottori University School of Medicine, Yonago, Japan
2006 Ph.D., Tottori University School of Medicine, Department of Urology
2006 Department of Urology, Tottori University Faculty of Medicine, Assistant Professor
2016 Department of Urology, Tottori University Faculty of Medicine, Senior Lecturer

Ryoma Nishikawa

Graduate Student
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

I am Ryoma Nishikawa, M.D., a graduate student of Department of Urology, Tottori University Faculty of Medicine.
2013.3 Graduated from Tottori University Faculty of Medicine
2013.4 Started resident program of Yonago Medical Center
2015.3 Finished resident program
2015.4 Clinical fellow of Department of Urology, Tottori University Faculty of Medicine
2016.4 Entered a graduate school of Tottori University Faculty of Medicine

Shogo Teraoka

Medical staff
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

I am Shogo Teraoka, M.D., a medical staff of Department of Urology, Tottori University Faculty of Medicine.
2013.3 Graduated from Tottori University Faculty of Medicine
2013.4 Started resident program of Tottori Prefectural Central Hospital
2015.3 Finished resident program
2015.4 Clinical fellow of Department of Urology, Tottori University Faculty of Medicine
2016.4 Entered a graduate school of Tottori University Faculty of Medicine

Yusuke Kimura

Assistant Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Tetsuya Yumioka

Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Tsounapi Panagiota

Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Hideto Iwamoto

Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Katsuya Hikita

Senior Lecturer
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Masashi Honda

Associate Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Masashi Honda, M.D., Ph.D., Associate Professor in Div. of Urology, Dept. of Surgery, Tottori University Facluty of Medicine, Yonago, Japan

APPOINTMENTS/EMPLOYMENT
2017−present Associate Professor in Div. of Urology, Dept. of Surgery, Tottori University Faculty of Medicine.
2016−present Delegate of the Japanese Urological Association.
2016−present Delegate of the Japanese Society of Endourology.
2016−2017 Senior Assistant Professor in in Div. of Urology, Dept. of Surgery, Tottori University Faculty of Medicine.
2014−present Delegate of the Japanese Continence Society.
2011−2016 Senior Assistant Professor in Dept. of Urology, Tottori University Hospital.
2007−2011 Assistant Professor in Dept. of Urology, Tottori University Hospital.
2006−2007 Research Fellow in Dept. of Urology, University of Pittsburgh, Pittsburgh, USA.
2003−2006 Assistant Professor in Dept. of Urology, Tottori University Hospital.
1997−1998 Resident in Dept. of Urology, Tottori University Hospital.

EDUCATION
Entered Tottori University Faculty of Medicine, April, 1991, and graduated March, 1997, with the degree of Bachelor of Medicine.
Obtained an M.D.. May, 1997.
Entered Dept. of Urology, Tottori University Graduate School of Medicine, April, 1998, and graduated March, 2002, with the degree of Ph.D.

Atsushi Takenaka

Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan