Predicting Factors for Lymph Node Metastasis in Anterior Prostatic Fat Tissue Excised During Radical Prostatectomy

Year 2020, Volume: 17 Issue: 2, 289 - 293, 20.08.2020

Fatih Akkaş , Yavuz Onur Danacioglu , Mustafa Yenice , Kamil Gökhan Şeker , Selçuk Şahin

https://doi.org/10.35440/hutfd.728011

Abstract

Background: Examination of the factors affecting lymph node incidence and lymph node metastasis in excised anterior prostatic fat tissue (APFT) in open radical prostatectomy and robot-assisted laparoscopic prostatectomy (RALP)
Materials and Methods: Between January 2018 and January 2020, 219 patients who underwent RALP in a single center were examined histopathologically for the presence of lymph node and lymph node metastasis. Factors predicting lymph node metastasis in APFT were investigated using descriptive statistics and multivariate analysis.
Results: Lymph node was detected in 21 cases (9.5%) in APYD. Lymph node metastasis was detected in 6 cases (2.7%). Two of the 6 cases were low and moderate risk patients without pelvic lymph node dissection (PLND). In two of the other 4 cases, metastasis was observed simultaneously in the pelvic lend node. In cases where metastasis was observed in APFT, total tumor volume, ISUP score, and pathological T stage were higher in univariate analysis than those with lymph node without metastasis. In multivariate analysis, these factors did not predict lymph node metastasis in APFT.
Conclusion: APFT is a tissue that has been proven to contain lymph nodes and metastases. Since APYD excision is a routine procedure applied to see the surgical field clearly during radical prostatectomy, pathological examination of these excised tissues will help make the staging more accurate.

Radikal Prostatektomide Eksize Edilen Anterior Prostatik Yağ Dokuda Lenf Nodu Metastazını Predikte Eden Faktörler

Abstract

Amaç: Açık radikal prostatektomi ve robot yardımlı laparoskopik prostatektomide (RYLP) cerrahi alanın net görülmesi için eksize edilen anterior prostatik yağ dokusunda (APYD) lenf nodu insidansı ve lenf nodu metastazını etkileyen faktörlerin incelenmesi
Materyal ve method: Ocak 2018 ve Ocak 2020 arasında tek merkezde RYLP yapılan 219 hastadan eksize edilen APYD lenf nodu varlığı ve lenf nodu metastazı açısından histopatolojik olarak incelendi. Tanımlayıcı istatistikler ve çok değişkenli analiz kullanılarak APYD’da lenf nodu metastazını predikte eden faktörler araştırıldı.
Bulgular: APYD’da lenf nodu oranı %9.5 olarak belirlendi. Bu olgular içerisinde 6 olguda (%2.7) lenf nodu metastazı saptandı. 6 olgunun ikisi pelvik lenf nodu diseksiyonu (PLND) yapılmayan düşük ve orta riskli hastaydı. Diğer 4 olgunun ikisinde eş zamanlı olarak pelvik lend nodunda metastaz izlendi. APYD’da metastaz izlenen olgularda toplam tümör volümü, ISUP skoru ve patolojik T evresi tek değişkenli analizde metastaz olmaksızın lenf nodu olanlara göre daha yüksek saptandı. Çok değişkenli analizde ise bu faktörlerin APYD’da lenf nodu metastazını predikte etmediği görüldü.
Sonuç: APYD lenf nodu barındırdığı ve mevcut lenf nodlarında metastaz geliştiği kanıtlanan bir dokudur. APYD’da lenf nodu eksizyonunun sadece radikal prostatektomi sırasında cerrahi alanın net görülmesi için uygulanan rutin bir prosedür olmaktan ziyade standart lenf nodu diseksiyonu şablonlarında yer alması gereken bir prosedür olduğu kabul edilmelidir.

Keywords

Prostat kanseri, Anterior prostatik yağ doku, Radikal prostatektomi

References

• 1. Gandaglia G, Sammon JD, Chang SL, Choueiri TK, Hu JC, Karakiewicz PI. Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination Era. J Clin Oncol. 2014;32(14):1419-26.
• 2. Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW. Robotic radical prostatectomy: A technique to reduce pT2 positive margins. Urology. 2004;64(6):1224-8.
• 3. Gil-Vernet JM. Prostate cancer: anatomical and surgical considerations. Br J Urol. 1996;78(2):161-8.
• 4. Salomon L, Anastasiadis AG, Levrel O, Katz R, Saint F, de la Taille A. Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer. Urology.2003;61(2):386-90.
• 5. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA. Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer. 280(11):6.
• 6. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480-7.
• 7. Fossati N, Willemse P-PM, Van den Broeck T, van den Bergh RCN, Yuan CY, Briers E. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur Urol. 2017;72(1):84-109.
• 8. Gandaglia G, Fossati N, Zaffuto E, Bandini M, Dell’Oglio P, Bravi CA. Development and Internal Validation of a Novel Model to Identify the Candidates for Extended Pelvic Lymph Node Dissection in Prostate Cancer. Eur Urol. 2017;72(4):632-40.
• 9. Roach M, Marquez C, Yuo HS, Narayan P, Coleman L, Nseyo UO. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1994;28(1):33-7.
• 10. Aning JJ, Thurairaja R, Gillatt DA, Koupparis AJ, Rowe EW, Oxley J. Pathological analysis of lymph nodes in anterior prostatic fat excised at robot-assisted radical prostatectomy. J Clin Pathol.2014;67(9):787-91.
• 11. Jeong J, Choi EY, Kang DI, Ercolani M, Lee DH, Kim W-J. Pathologic implications of prostatic anterior fat pad. Urol Oncol Semin Orig Investig.2013;31(1):63-7.
• 12. Finley DS, Deane L, Rodriguez E, Vallone J, Deshmukh S, Skarecky D. Anatomic Excision of Anterior Prostatic Fat at Radical Prostatectomy: Implications for Pathologic Upstaging. Urology. 2007;70(5):1000-3.
• 13. Does anterior prostatic fat tissue removed during robotic radical prostatectomy contain any lymph nodes? Cent Eur J Urol. 2015: 68:410-4
• 14. Yuh B, Wu H, Ruel N, Wilson T. Analysis of regional lymph nodes in periprostatic fat following robot-assisted radical prostatectomy: Lymph nodes in periprostatic fat. BJU Int.2012;109(4):603-7.
• 15. Kim IY, Modi PK, Sadimin E, Ha Y-S, Kim JH, Skarecky D. Detailed Analysis of Patients with Metastasis to the Prostatic Anterior Fat Pad Lymph Nodes: A Multi-Institutional Study. J Urol. 13;190(2):527-34.
• 16. Hosny M, Rai B, Aljaafari F, Agarwal S, McNicholas T, Boustead G. Can Anterior Prostatic Fat Harbor Prostate Cancer Metastasis? A Prospective Cohort Study. Curr Urol. 2016;10(4):182-5.
• 17. Hansen J, Budäus L, Spethmann J, Schlomm T, Salomon G, Rink M. Assessment of Rates of Lymph Nodes and Lymph Node Metastases in Periprostatic Fat Pads in a Consecutive Cohort Treated With Retropubic Radical Prostatectomy. Urology. 2012;80(4):877-82.