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Impact of metastatic lymph node burden on survival in patients with mHSPC from the 'docetaxel comparison' of the STAMPEDE trial
Haran, Aine M Ali, Adnan Hoyle, Alex P Hambrock, Thomas Jain, Yatin Brawley, C. Amos, C. Calvert, J. Attard, G. Douis, H.
Haran, Aine M
Ali, Adnan
Hoyle, Alex P
Hambrock, Thomas
Jain, Yatin
Brawley, C.
Amos, C.
Calvert, J.
Attard, G.
Douis, H.
Citations
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Abstract
Background: Increasing metastatic burden is associated with worsening prognosis.
However, none of the current burden definitions consider metastatic lymph node
volume, number and distribution. In this exploratory analysis of cross-sectional
baseline staging scans from the STAMPEDE "docetaxel comparison” we evaluate
metastatic lymph node burden as a prognostic factor.
Methods: 629 patients with metastatic disease randomised between 2005 and 2013
to Arm A (androgen deprivation therapy (ADT)) or Arm C (ADT + docetaxel) with
available baseline scans were analysed. Lymph node analysis was done using the UK
Royal College of Radiologists diagnostic criteria with central review of CT/MRI scans
performed jointly by a radiologist and urologist. Annotation of lymph node number
and size was completed for both regional and non-regional sites. Overall survival (OS)
and failure-free survival (FFS) were used as endpoints. Hazard ratios were obtained
separately for each treatment group using multivariable Cox regression analysis
adjusted for age (<70 or 70), WHO PS (0 or 1-2), nodal status (N0, N1 or NX), NSAID
or aspirin use (uses either or no), Gleason score ( 7, 8-10 or unknown), bone metastases
counts (<5 or 5) and concomitant metastatic site (only metastatic lymph
nodes, bone (+/-NRLN) or any visceral (+/-bone)).
Results: 178/629 (29%) patients had nodal metastases with a median maximum
diameter of 2.1 (range 1.0 to 8.1) cm and median minimum diameter of 1.2 (range 0.9
to 3.9) cm. 87/629 (14%) patients had 5 or more nodes. Patients with 5 metastatic
nodes had worse OS compared to patients with <5 nodes in both the ADT group
(HR¼1.61, 95%CI 1.12e2.31, p¼0.013; 5yr KM estimated OS 27% for 5 NRLN vs
40% for <5NRLN) and ADT + docetaxel group (HR¼1.79, 95%CI 1.10e2.92, p¼0.024;
5yr OS 35% vs 53%). FFS was also worse for patients with 5 nodes in the ADT group
(HR¼1.51, 95%CI 1.07e2.14, p¼0.024) and the ADT + docetaxel group (HR¼1.78,
95%CI 1.12e2.81, p¼0.018).
Conclusions: Increased metastatic burden of 5 or more nodal metastases is an independent
prognostic factor for poorer outcomes in patients with mHSPC treated
with ADT or ADT + docetaxel and should be considered for inclusion along with bone
metastases counts in future metastatic burden definitions.
Description
Date
2020
Publisher
Collections
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Keywords
Type
Meetings and Proceedings
Citation
Haran AM, Ali A, Hoyle A, Hambrock T, Jain Y, Brawley C, et al. 634P Impact of metastatic lymph node burden on survival in patients with mHSPC from the docetaxel comparison” of the STAMPEDE trial. Annals of Oncology. 2020;31:S522-S3.#10.1016/j.annonc.2020.08.893