Pd01-07 Natural History of Pn1 Prostate Cancer After Radical Prostatectomy: Competing Risk Analysis From a Large Multi-Institutional Series

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) I (PD01)1 May 2024PD01-07 NATURAL HISTORY OF PN1 PROSTATE CANCER AFTER RADICAL PROSTATECTOMY: COMPETING RISK ANALYSIS FROM A LARGE MULTI-INSTITUTIONAL SERIES Daimantas Milonas, Kaunas Lithuania, Alexander Giesen, Lorenzo Tosco, Annouschka Laenen, Zilvinas Venclovas, Gaëtan Devos, Alberto Briganti, Paolo Gontero, Markus Graefen, Piotr Chlosta, Christian Gratzke, Giansilivio Marchioro, Rafael Sanchez-Salas, Bertrand Tombal, Henk Van Der Poel, Van Poppel Hendrik, R. Jeffrey Karnes, Martin Spahn, De Meerleer Gert, and Joniau Steven Daimantas MilonasDaimantas Milonas , Kaunas LithuaniaKaunas Lithuania , Alexander GiesenAlexander Giesen , Lorenzo ToscoLorenzo Tosco , Annouschka LaenenAnnouschka Laenen , Zilvinas VenclovasZilvinas Venclovas , Gaëtan DevosGaëtan Devos , Alberto BrigantiAlberto Briganti , Paolo GonteroPaolo Gontero , Markus GraefenMarkus Graefen , Piotr ChlostaPiotr Chlosta , Christian GratzkeChristian Gratzke , Giansilivio MarchioroGiansilivio Marchioro , Rafael Sanchez-SalasRafael Sanchez-Salas , Bertrand TombalBertrand Tombal , Henk Van Der PoelHenk Van Der Poel , Van Poppel HendrikVan Poppel Hendrik , R. Jeffrey KarnesR. Jeffrey Karnes , Martin SpahnMartin Spahn , De Meerleer GertDe Meerleer Gert , and Joniau StevenJoniau Steven View All Author Informationhttps://doi.org/10.1097/01.JU.0001009540.33579.43.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymph node positive (pN1) prostate cancer (PCa) is a heterogeneous disease, and a clear definition of prognostic groups is urgently needed. We aimed to assess cancer-related mortality (CRM) in different risk groups of pN1 patients, created based on pathological PCa characteristics and number of positive lymph nodes (LN+). METHODS: We conducted a retrospective, multicenter cohort study including 894 consecutive patients with pN1 disease and known number of LN+ treated at fifteen European high-volume centers. A prognostic model was constructed for the prediction of CRM, accounting for death from other causes (OCM) as a competing risk. In the different risk groups, the ten-year cumulative risk of mortality was assessed. RESULTS: Combinations of predictive characteristics (pT-stage, ISUP score, number of LN+ and surgical margin SM status) were compared and pooled until all remaining subgroups differed significantly. We ended with a model including three risk groups, based on pT-stage, surgical margin status and number of LN+. The low-risk group includes patients with pT1-3a, 1-4 LN+ and either positive or negative SM. Patients with pT3b-4 disease and negative SM are also part of the low-risk group, independent of the number of LN+. Regarding the medium-risk group, patients with pT1-3a disease and>4 LN+ were included, independent of SM. Patients with pT3b-4 disease, 1-4 LN+ and positive SM were also part of the medium-risk group. Patiets with high-risk had all 3 high-risk factors present: pT3b-4, >4 LN+ and positive SM.The discriminative value (C-index) of this model was 0.73. Ten-year cumulative CRM in low-, medium-, and high-risk groups were 12% (95% CI: 7.3-16%), 32% (24-40%), and 58% (40-76%), respectively (Figure 1), with significant difference between all groups (hazard ratio (HR) 2.2 to 6.4, p<0.005). Ten-year OCM were 12% (7.6-16%), 16% (9.5-22%), and 9.6% (0.4-19%), respectively. CONCLUSIONS: The pN1 patient population is extremely heterogeneous with an increased risk of death from PCa rather than death from other causes. In this group of patients, primary cancer characteristics (pT-stage, number of LN+ and surgical margin status) still represent the driving factors of CRM. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e65 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Daimantas Milonas More articles by this author Kaunas Lithuania More articles by this author Alexander Giesen More articles by this author Lorenzo Tosco More articles by this author Annouschka Laenen More articles by this author Zilvinas Venclovas More articles by this author Gaëtan Devos More articles by this author Alberto Briganti More articles by this author Paolo Gontero More articles by this author Markus Graefen More articles by this author Piotr Chlosta More articles by this author Christian Gratzke More articles by this author Giansilivio Marchioro More articles by this author Rafael Sanchez-Salas More articles by this author Bertrand Tombal More articles by this author Henk Van Der Poel More articles by this author Van Poppel Hendrik More articles by this author R. Jeffrey Karnes More articles by this author Martin Spahn More articles by this author De Meerleer Gert More articles by this author Joniau Steven More articles by this author Expand All Advertisement PDF downloadLoading ...