Prostate Cancer Topography and Patterns of Lymph Node Metastasis
Y Tokuda, M Kaag, A Gopalan, SK Tickoo, B Guillonneau, JA Eastham, PT Scardino, HI Scher, VE Reuter, SW Fine. Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Pelvic lymph node dissection is the standard means of detecting lymph node metastases (LN+) in men with prostate cancer (CA). We examined the correlation of primary tumor topography in radical prostatectomies (RP) and patterns of LN metastasis.
Design: In 125 LN+ cases, entirely-submitted/whole-mounted RP specimens and corresponding lymph node dissections were reviewed. For primary CA, tumor maps were constructed with annotation of low (Gleason pattern < 3) and high grade (Gleason patterns 4-5) CA. Laterality, anterior-posterior and apex/mid/base localization, extraprostatic extension [EPE], seminal vesicle invasion [SVI], lymphovascular invasion [LVI], and tumor volume [TV] were noted. Total # of LN excised and # and laterality of LN+ were also recorded.
Results: LN Quantity and Distribution - Total # LN resected: range: 4 to 48 (mean=14.5; median=13) - 76 of 125 cases had 1 LN+, 33 had 2 LN+, and 16 had >2 LN+ (range: 3 to 18) - 58 cases had LN+ on the right [R], 44 on the left [L], and 20 bilateral (unknown in 3 cases) Pathologic Variables for LN+ Cases - 74 of 115 (64%) evaluable cases showed LVI - 108 of 125 (86%) cases showed EPE and 45 (37%) demonstrated SVI (17 R, 12 L, and 17 bilateral) - Among cases with SVI, 27/46 (59%) had > 1 LN+, compared with 22/78 (28%) without SVI - Volumetric studies revealed mean and median total TV of 6.38 and 3.92 cc, respectively (range: 0.03 to 45.7) - Predominantly high grade Gleason patterns (4-5) accounted for > 50% of total TV in 105 (84%) cases and > 90% of total TV in 73 (58%) cases Correlation of Dominant Lesion Location and LN+ - Dominant lesions on RP: 50 R lobe, 44 L lobe, 31 bilateral lobes - R lobe dominant tumors: 14/50 (28%) showed LN+ on the L side (9 exclusively left LN+, 5 bilateral LN+). L lobe dominant tumors: 17/44 (39%) showed LN+ on the R side (8 exclusively right LN+, 9 bilateral LN+) - 102/125 were posterior/posterolateral, 18 were both anterior/posterior, and 5 were anterior only - 79 primary tumors involved the base, while 46 were located primarily in the apex-mid gland - 13 of 16 CA with LN+, but without EPE or SVI, were predominantly in the apex-mid gland.
Conclusions: LN+ cases are overwhelmingly associated with large volume, high grade, high stage (> pT3a) disease and LVI. Interestingly, one-third of LN+ occur contralateral to the dominant RP cancer. In this series, LN+ were infrequently associated with anterior-dominant tumors. Organ-confined LN+ cases were predominantly situated in the apex-mid gland.
Category: Genitourinary (including renal tumors)
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 114, Wednesday Morning