Evaluating the efficacy and safety of pelvic lymph node dissection in high-risk prostate cancer patients undergoing radical prostatectomy: A systematic review and meta-analysis.

Abstract

390 Background: Pelvic lymph node dissection (PLND) is currently considered the gold standard for lymph node staging in prostate cancer patients. However, there is a paucity high-quality evidence demonstrating an oncological prognostic benefit of PLND in high-risk prostate cancer (PCa) populations, as defined by D'Amico risk classification. Methods: We conducted a comprehensive systematic literature review utilizing MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE databases. The search encompassed studies up to June 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We identified original articles published in journals that reported survival analyses using Cox regression analysis and differences in hazard ratios (HRs) for the biochemical recurrence (BCR)-free survival (BRFS) (primary outcome) and metastasis-free survival (MFS), overall survival (OS) or cancer specific survival (CSS) (secondary outcomes). A meta-analysis of the effect of PLND on primary and secondary endpoints was performed using a random effects model. Results: Our analysis included seven studies, comprising one prospective and the rest retrospective. Pooled outcome data showed that PLND after radical prostatectomy did not independently predict BRFS (HR: 1.22; 95%CI: 0.99-1.50; p=0.006), MFS (HR: 1.21; 95%CI: 0.86-1.70; p=0.27), OS (HR: 0.91; 95%CI: 0.74-1.12; p=0.37), or CSS(HR: 1.02; 95%CI: 0.74-1.42; p=0.89) in high-risk prostate cancer patients. Heterogeneity was low to moderate. Conclusions: The available pooled analyses suggest that the therapeutic value of PLND is unclear. The high-risk PCa population should be carefully selected for lymph node dissection.