Risk Stratification of pN+ XXXX after Radical Prostatectomy from a Large Single Institutional Series with Long-Term Followup.

@entity1 @entity263 @entity5 @entity3
PURPOSE: Lymph node positive (pN+) @entity263 after radical prostatectomy has wide variability in long-term oncologic outcomes. We present a large institutional series with extended followup to create an oncologic risk stratification system that clarifies the prognostic heterogeneity for @entity1 with pN+ disease after radical prostatectomy. MATERIALS AND METHODS: @entity1 with pN+ @entity263 after radical prostatectomy during 1987 to 2012 were included in the study. Regression models were created to identify significant predictors of biochemical recurrence, @entity3 , @entity5 specific mortality and overall mortality. A @entity5 specific mortality risk score was then created and internally validated to stratify @entity1 in terms of risk of @entity5 specific mortality. RESULTS: For our cohort of 1,011 @entity1 with a median followup of 17.6 years the 20-year rate of @entity5 specific mortality was 31%. On multivariate Cox regression modeling 3 or more positive nodes (HR 1.75, p=0.003), pathological Gleason score 7 vs 6 (HR 1.74, p=0.04) and 8-10 vs 6 (HR 2.63, p=0.001), and positive surgical margins (HR 1.96, p=0.001) were significantly associated with increased @entity5 specific mortality, while adjuvant radiotherapy (HR 0.40, p=0.008) was associated with decreased @entity5 specific mortality. A @entity5 specific mortality risk score was then created using these 4 variables to stratify @entity1 with markedly different prognoses, yielding 20-year @entity5 specific mortality rates of 19.1% vs 34% vs 46% (p <0.001) for low, intermediate and high risk categories, respectively. CONCLUSIONS: The prognosis of @entity1 with pN+ @entity263 varied significantly after radical prostatectomy. A risk score created using the number of positive nodes, pathological Gleason score, margin status and adjuvant radiotherapy status successfully separated @entity1 into low, intermediate and high risk groups.
