PROGNOSTIC IMPLICATIONS OF EXTRACAPSULAR EXTENSION OF LYMPH-NODE METASTASES IN PROSTATE-CANCER

We performed a retrospective review of surgical pathology specimens an d clinical data for all patients with node-positive prostate cancer di agnosed in our institutions between 1985 and 1994. We used adjusted ac tuarial survival analyses and univariate and multivariate analyses to evaluate the clinical significance of extracapsular perinodal tumor ex tension. Sixty patients with histologically confirmed prostate cancer metastatic to regional lymph nodes were reviewed. Forty-two patients ( 70%) had evidence of extracapsular extension of the tumor into perinod al tissue. The 5-year adjusted cumulative survival rates for patients with extracapsular nodal extension was 54.6%, compared with 71.4% for patients with histologically confined nodal metastases (P < .05). Univ ariate and multivariate analyses revealed the presence of extracapsula r nodal tumor extension to be an independent predictor of patient surv ival. In this study, only the histologic grade (Gleason score) of the primary tumor was a stronger predictive factor. These data suggest tha t histologic evidence of extracapsular tumor extension from lymph node metastases into perinodal tissue might be an important prognostic fac tor in patients with node-positive adenocarcinoma of the prostate. Dev elopment of a pathologic substage to include this feature might be war ranted.