Marked Prognostic Impact of Minimal Lymphatic Tumor Spread in Prostate Cancer

Abstract Background Nodal metastasis (N1) is a strong prognostic parameter in prostate cancer; however, lymph node evaluation is always incomplete. Objective To study the prognostic value of lymphatic invasion (L1) and whether it might complement or even replace lymph node analysis in clinical practice. Design, setting, and participants Retrospective analysis of pathological and clinical data from 14 528 consecutive patients. Intervention Radical prostatectomy. Outcome measurements and statistical analysis The impact of L1 and N1 on patient prognosis was measured with time to biochemical recurrence as the primary endpoint. Results and limitations Nodal metastases were found in 1602 (12%) of 13 070 patients with lymph node dissection. L1 was seen in 2027 of 14 528 patients (14%) for whom lymphatic vessels had been visualized by immunohistochemistry. N1 and L1 continuously increased with unfavorable Gleason grade, advanced pT stage, and preoperative prostate-specific antigen (PSA) values ( p p p p Conclusions Analysis of lymphatic invasion provides comparable prognostic information than lymph node analysis. Even minimal involvement of the lymphatic system has pivotal prognostic impact in prostate cancer. Thus, a thorough search for lymphatic involvement helps to identify more patients with an increased risk for disease recurrence. Patient summary Already minimal amounts of tumor cells inside the lymph nodes or intraprostatic lymphatic vessels have a severe impact on patient prognosis.