Examining the association between real-world extended vs. standard pelvic lymph node dissection and early and late oncologic outcomes in men undergoing radical prostatectomy
Bibliographic record
Abstract
INTRODUCTION: In patients with prostate cancer (PCa), the impact of extended pelvic lymph node dissection (E-PLND) during radical prostatectomy (RP) on oncologic outcomes remains controversial. This study examined the association between extended vs. standard PLND (S-PLND) and biochemical recurrence (BCR), an early outcome, as well as metastatic PCa (mPCa), and castration-resistant PCa (CRPC) development, late outcomes, in a multi-institutional cohort. METHODS: High-risk post-RP patients from a Canadian PCa database were analyzed from January 1, 2005, to December 31, 2016. The association between PLND and BCR, mPCa, and CRPC development and complication rate was examined using regression and correlation analysis. RESULTS: Data were collected from patients who underwent S-PLND (n=494) and E-PLND (n=107). The median followup was 40.1 months, and time to BCR, mPC, and CRPC development was 9.8, 46.0, and 52.1 months, respectively. The median (interquartile range) number of lymph nodes extirpated was 7 (7) and 14 (11) for the S-PLND and E-PLND groups, respectively. E-PLND was associated with increased intraoperative blood loss and higher postoperative complication rate. There were no differences in BCR-free survival based on PLND approach, with 67.1% of S-PLND cases and 71.1% of E-PLND cases reaching BCR-free survival at the end of the followup period (hazard ratio [HR] 0.784 [0.506, 1.215], p=0.28). PLND extent was not a predictor for mPCa progression (p=0.963). Similarly, there were no differences in CRPC-free survival based on dissection type (S-PLND 90.9% vs. E-PLND 89.1%, p=0.561). Lymph node positivity was predictive of BCR, mPCa, and CRPC progression. CONCLUSIONS: E-PLND did not show significant differences in the rates of BCR, mPCa, or CRPC progression when compared to S-PLND. E-PLND was associated with higher complication rates. This study adds to the data exploring the association between PLND and PCa oncologic outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".