Presentation Authors: Raisa Pompe*, Hamburg, Germany, Pierre I. Karakiewicz, Zhe Tian, Montreal, Canada, Felix Preisser, Philipp Mandel, Frankfurt, Germany, Philipp Gild, Thomas Steuber, Georg Salomon, Markus Graefen, Margit Fisch, Hartwig Huland, Derya Tilki, Hamburg, Germany
Introduction: To describe oncological outcomes of patients with high lymph node burden (â‰¥4 positive nodes) and to assess the impact of adjuvant therapies.
Methods: We retrospectively analyzed 273 patients with â‰¥4 positive lymph nodes after radical prostatectomy (RP) and lymph node dissection between 2007 and 2015. Patients received adjuvant androgen deprivation therapy (aADT), aADT plus adjuvant radiation (aRT) or observation (including salvage ADT). Kaplan-Meier curves as well as multivariable Cox-regression analyses compared biochemical recurrence (BCR), metastatic progression (MP) and overall mortality (OM) between the different treatment modalities.
Results: Overall 55 patients received aADT, 34 aADT + aRT and 184 observation (including 96 with salvage ADT). For the entire cohort 2-year BCR-free survival, MP-free survival and overall survival rates were 33.0% (27.2-40.1%), 76.6% (71.0-82.8%) and 90.3% (86.1-94.8%). While patients with aADT + aRT had significantly better BCR-free survival rates (78.6% vs. 29.7% (aADT) vs. 25.8% (observation), p < 0.001) MP-free survival and overall survival did not differ between the groups (p>0.05). In multivariable Cox regression analyses aADT+aRT was significantly associated with a lower BCR rate (HR aADT: 5.55, HR observation: 6.15, both p < 0.001), while there was no effect on MP or overall mortality (p>0.05).
Conclusions: In patients with high lymph node burden, combination of aADT+aRT might lower BCR risk. However, further oncological outcomes, namely MP and overall mortality, were not affected by the addition of radiation therapy.