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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2020

01-06-2020 | Prostate Cancer | Urologic Oncology

Facility-Level Variation in Pelvic Lymphadenectomy During Radical Prostatectomy and Effect on Overall Survival in Men with High-Risk Prostate Cancer

Authors: David F. Friedlander, MD, MPH, Marieke J. Krimphove, MD, Alexander P. Cole, MD, Karl H. Tully, MD, Stuart R. Lipsitz, ScD, Adam S. Kibel, MD, Kerry L. Kilbridge, MD, Quoc-Dien Trinh, MD

Published in: Annals of Surgical Oncology | Issue 6/2020

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Abstract

Purpose

This study was designed to examine facility-level variation in the extent of pelvic lymphadenectomy and to determine whether more extensive lymphadenectomy is associated with a survival benefit among men with localized high-risk prostate cancer.

Methods

Using data from the National Cancer Data Base, we identified 13,652 men with a high predicted probability of 10-year survival (≤ 65 years of age and Charlson Comorbidity Index score of 0) who underwent radical prostatectomy at 1023 facilities for biopsy-confirmed localized high-risk prostate cancer diagnosed between January 2004 and December 2011. Multilevel, multinomial logistic regression was fitted to predict facility-level probability of receiving different extents of lymphadenectomy. Inverse probability of treatment weighting-adjusted Cox regression model with Bonferroni correction was fitted to compare risk of overall mortality.

Results

Overall, 11,284 (82.7%), 1601 (11.7%), and 767 (5.6%) men who underwent radical prostatectomy underwent concomitant none/limited lymphadenectomy (0–9 lymph nodes), standard lymphadenectomy (10–16 lymph nodes), and extended lymphadenectomy (≥ 17 lymph nodes), respectively. Extended lymphadenectomy was not associated with a survival benefit relative to standard lymphadenectomy (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.48–1.23; p = 0.4) nor no/limited lymphadenectomy (HR 0.77, 95% CI 0.87–2.20; p = 0.29) at a median follow-up of 83.3 months. Risk-adjusted facility-level predicted probabilities of extended, standard, or no/limited lymphadenectomy ranged from 0.01 to 52.6%, 3.3–53.3%, and 17.8–96.3%, respectively.

Conclusions

We found significant facility-level variation in the extent of pelvic lymphadenectomy during radical prostatectomy despite no apparent survival benefit associated with more extensive lymphadenectomy. Further prospective data are needed to reevaluate the role of lymphadenectomy in the management of clinically localized prostate cancer.
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Metadata
Title
Facility-Level Variation in Pelvic Lymphadenectomy During Radical Prostatectomy and Effect on Overall Survival in Men with High-Risk Prostate Cancer
Authors
David F. Friedlander, MD, MPH
Marieke J. Krimphove, MD
Alexander P. Cole, MD
Karl H. Tully, MD
Stuart R. Lipsitz, ScD
Adam S. Kibel, MD
Kerry L. Kilbridge, MD
Quoc-Dien Trinh, MD
Publication date
01-06-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-08110-3

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