Clinical Significance of Pathological Lymph Node Status in Prostate Cancer Patients Undergoing Radical Prostatectomy: A 25-Year Institutional Cohort Study.

BACKGROUND: While the therapeutic value of pelvic lymph node dissection (PLND) remains controversial, the pathological lymph node status itself may provide important prognostic information after radical prostatectomy (RP). METHODS: Among 610 consecutive patients who underwent RP between January 2000 and December 2019, with follow-up through December 2024, we retrospectively analyzed 445 patients with intermediate- or high-risk disease according to the D'Amico classification who underwent PLND. Patients were stratified according to the pathological lymph node status into pN0 (n = 416) and pN1 (n = 29) groups. The primary endpoint was overall survival (OS), and secondary endpoints included biochemical recurrence (BCR) and the prognostic significance of pathological lymph node status. RESULTS: The median age of the cohort was 68 years. BCR occurred in 26% of the pN0 patients, with a median time to BCR of 29 months, and in 41% of pN1 patients, with a median time to BCR of 47 months. During follow-up, 38 all-cause deaths (9.1%) occurred in the pN0 group and 9 (31.0%) in the pN1 group. Kaplan-Meier analysis showed no significant difference in BCR-free survival between groups, whereas OS was significantly worse in the pN1 group (hazard ratio: 2.768; 95% confidence interval: 1.315-5.829; p = 0.007). Ten-year OS rates were 94% for pN0 patients and 74% for pN1 patients. Multivariable analysis identified the pN1 status and postoperative Gleason score of 7 as independent prognostic factors for OS. CONCLUSIONS: Pathological lymph node positivity is a strong independent predictor of inferior OS in patients undergoing RP for localized prostate cancer. These findings underscore the need for tailored postoperative management strategies in patients with node-positive disease.