PATHOLOGICAL SENTINEL LYMPH NODE STATUS IN MORE 200 PROSTATE CANCER PATIENTS: WHAT IMPACT ON SURVIVAL WITHOUT RECURRENCE?

1561 Objectives Due to the concept of (SLN) sentinel lymph node (pathologic status of SLN reflects the other pathologic lymph nodes status), SLN should contain decisive information for clinical outcome. This study assessed the clinical outcome after laparoscopic prostatectomy associated with isotopic SLN detection and extensive pelvic resection (ePLND) in localized prostate cancer (PCa) patients. Methods From June 2008 until December 2014, a total of 227 consecutive patients were analyzed. Biochemical recurrence-free survival (RFS) and overall survival (OS) were assessed with Kaplan-Meier curves. Various histopathological parameters were analyzed by univariate and multivariate analysis. Results The median follow-up was 3.94 years [3.72-4.23]. Lymph node (LN) metastases occurred in 49 patients. We removed an average of 26.4±10.5 LNs via ePLND and 5.72±3.75 SLN. At the time of final follow-up, 24.9% (62/227) patients had recurrences but not enough events for OS evaluation were noted. In univariate analysis, for characteristics of primary tumor, pT stage, Gleason score, percentage of positive biopsy cores and intersection margin significantly affected the RFS (p<10-4 to 10-6). Concerning LN metastases, the most relevant data were the number of metastases both in LN than in SLN and the presence of SLN macro-metastases (p<10-12 to 10-15). In the multivariate analysis (Cox regression analysis) evaluating RFS, one of the most significant prognostic factor was evidence of macro- or micro-metastases only in SLN with a hazard ratio of 5.25 [95%CI: 2.83-9.74] (p Conclusions SLN detection seems to contain decisive information for the clinical outcome of patients with localized PCa because metastatic or non-metastatic status of SLN had a strong impact on the RFS. The question arises as to propose immediate postoperative additional treatment to patients with metastatic SLN as the study of Muck et al. suggests1. 1Muck A et al. Urol Int. 2015;94(3):296-306.