The Prognostic Role of Lymph Node Dissection for High-Risk Localized Prostate Cancer Patients: A Population-Based, Retrospective Cohort Study

The role of lymph node dissection in radical prostatectomy in the survival of patients with clinical N0 high-risk localized prostate cancer, has not yet been elucidated. Patients with high-risk localized prostate cancer who underwent radical prostatectomy ± lymph node dissection were identified in the Surveillance Epidemiology and End Results (SEER) (2010–2015). Patients were divided into two groups: no lymph node dissection (LNN group) and lymph node dissection (LND group). Propensity score matching (PSM) was used to balance the baseline characteristics. Overall survival and cancer-specific survival were analyzed using Kaplan–Meier's method and cox multivariate analyses, and subgroup analyses according to the Gleason score were performed. After PSM, there were 12,309 pairs of White patients in the LNN and LND group, age (odds ratio [OR] = 1.076, 95% confidence interval, CI 1.066–1.087, p < 0.001), Gleason score 7 (OR = 0.542, 95% CI 0.432–0.680, p < 0.001), and Gleason score > 7 (OR = 0.531, 95% CI 0.441–0.640, p < 0.001) were associated with overall survival. Subgroup analysis indicated that LND contributed to a limited 2 months better prognosis for patients with a Gleason score > 7 (101.97 VS 99.33 months, p = 0.013), but not for patients with a Gleason score of 7 (103.90 VS 104.16 months, p = 0.24), comparing to these LNN groups. No significant difference was found in subgroup analysis for the Black population when OS and CSS were compared between the no lymph node dissection and lymph node dissection groups. Patients with high-risk prostate cancer should be carefully selected for lymph node dissection. Only some patients can obtain short-term survival benefits, while other patients cannot benefit from lymph node dissection but have the risk of increased complications.