Pelvic Lymphadenectomy May Not Improve Biochemical Recurrence-Free Survival in Patients with Prostate Cancer Treated with Robot-Assisted Radical Prostatectomy in Japan (The MSUG94 Group).

In this multicenter retrospective cohort study, we aimed to evaluate whether pelvic lymph node dissection (PLND) improved biochemical recurrence (BCR) in patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy (RARP) in Japan. A multicenter retrospective cohort study of 3195 PCa patients undergoing RARP at nine institutions in Japan was conducted. Enrolled patients were divided into two groups: those who underwent RARP without PLND (non-PLND group) and those who underwent PLND (PLND group). The primary endpoint was biochemical recurrence-free survival (BRFS) in PCa patients who underwent PLND. We developed a propensity score analysis to reduce the effects of selection bias and potential confounding factors. Propensity score matching resulted in 1210 patients being enrolled in the study. The 2-year BRFS rate was 95.0% for all patients, 95.8% for the non-PLND group, and 94.3% for the PLND group (p = 0.855). For the all-risk group according to the National Comprehensive Cancer Network risk stratification, there were no significant differences between patients who did and did not undergo PLND. Based on the results of the log-rank study, PLND may be unnecessary for patients with PCa undergoing RARP.

Short-term oncological and surgical outcomes of robot-assisted radical prostatectomy: A retrospective multicenter cohort study in Japan (the MSUG94 group).

INTRODUCTION: We evaluated oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) and their perioperative complications in Japan. We investigated clinical and pathological covariates to predict biochemical recurrence (BCR) after RARP. METHODS: A retrospective multicenter cohort study was conducted in RARP patients with PCa at 10 institutions in Japan. Pre- and postoperative covariates were collected from enrolled patients. The primary endpoint was defined as biochemical recurrence-free survival (BRFS). Additionally, the association between BCR and clinicopathological covariates was determined. RESULTS: We enrolled 2670 patients in this study. The median follow-up period was 26.0 months. RARP-related perioperative complications were identified in 198 patients (7.4%), including 69 patients (2.6%) with grade 3/4 complications according to the Clavien-Dindo classification. The 2-year BRFS was 88.0%. Using the Kaplan-Meier method, initial prostate-specific antigen (PSA) level of ≤7.6 ng/mL, biopsy and pathological Gleason score (GS) of ≤7, clinical and pathological T1/2, and low/intermediate risks according to the National Comprehensive Cancer Network risk classification, and negative surgical margin status had significant BRFS than their counterparts. In multivariate analysis, initial PSA, biopsy and pathological GS, clinical and pathological T stage, and surgical margin status significantly correlated with BCR after RARP. CONCLUSION: In this study, RARP achieved a lower incidence of perioperative complications than other studies.

[A case of metastatic renal cell carcinoma with no evidence of disease for a long term after a favorable response to molecular-targeted therapy followed by metastasectomy].

We report a case of metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy, cytokine therapy, and molecular targeted therapy followed by metastasectomy. A 47-year-old man was diagnosed as having bilateral RCC with metastases to the lung, liver, left adrenal gland, and lymph nodes in the mediastinum. He initially received right radical nephrectomy, left partial nephrectomy, and left adrenalectomy. The pathological diagnosis was clear cell RCC, which was found in all excised specimens. After the initial surgery, cytokine therapy was started but it did not generate a response in the evaluation at 3 months. He then received sorafenib for 2.5 years and the treatment produced a 75% response rate with only one metastasis remaining. The following sequential therapy with everolimus and sunitinib did not reduce the size of the lung metastasis. For a long time, the metastasis was limited only to the lung and its size did not become larger and there were no new lesions in any organs. Then, lung metastasectomy was performed. From the time of surgery in January 2010 until November 2012, he has had no recurrence of the disease. In some selected cases, sequential therapy with targeted agents followed by metastatectomy may result in a favorable clinical outcome for patients with metastatic RCC.