Comparison between site N-category and number N-category for nodal staging in carcinoma of the gastroesophageal junction: our experience and literature review

Gastroesophageal junction (GEJ) neoplasms have become more common over the past decade. Like mediastinal and abdominal lymph nodes and other gastric tumors, GEJ tumors spread to the retroperitoneal nodes. The TNM staging system does not consider this pattern and does not clinically distinguish GEJ tumors from gastric and esophageal cancers. The aim of the study is to compare the old and new TNM staging systems to assess whether the new TNM classifies lymph node involvement in these tumors as a prognostic factor. From January 1983 to December 1995, 438 patients underwent curative gastric resections for cancer at the Department of Surgery "P. Valdoni" of the University of Rome "La Sapienza". Sixty-two had GEJ type II and III tumors according to the Siewert classification system. The old pN1 and new pN1 survival rates (P < 0.05) were statistically different; the old pN2 and new pN2 survival rates (P = 0.483) were not. The multivariate analysis of significant statistical prognostic factors showed that the pTNM staging in type II and type III GEJ tumors is the most important prognostic factor (P < 0.001), followed by the old pN and new pN (P < 0.001) and the pT (P < 0.005). Gender, age, Lauren type, and tumor location according to Siewert (II vs III) were not independently significant prognostic factors. This study concludes that the numbers and locations of metastatic lymph nodes are important prognostic factors that should be included in the next TNM edition.     

Comparison of old and new TNM systems for nodal staging in adenocarcinoma of the gastro-oesophageal junction

BACKGROUND: Adenocarcinoma of the gastro-oesophageal junction is considered a distinct clinical entity, although the current pathological tumour node metastasis (pTNM) classification does not consider this tumour specifically. A prospective study was undertaken to determine the prognostic importance of lymph node involvement in adenocarcinoma of the gastro-oesophageal junction, analysing both a number- and site-based classification, in order to develop a clinically useful nodal staging system. METHODS: Two classification systems were analysed in 116 patients who underwent resection for adenocarcinoma of the gastro-oesophageal junction from January 1988 to August 2001. The Cox regression model was used to evaluate the prognostic significance of the site and number of positive nodes. RESULTS: The number- and site-based staging systems coincided only in 42 (56 per cent) of 75 patients; in particular, the old pN1 classification was upstaged in 13 of 41 patients and the old pN2 was downstaged in 13 of 34 patients. Lymph node involvement was the most important prognostic factor in both classifications (P < 0.001). The risk of death was significantly influenced by the site of nodal metastasis among patients with a similar number of involved nodes (relative risk with respect to pN0: 2.18 for pN1 with one to six nodes; 6.53 for pN2 with one to six nodes; 7.53 for pN1 with more than six nodes; 39.13 for pN2 with more than six nodes). CONCLUSION: Adenocarcinoma of the gastro-oesophageal junction requires a specific lymph node classification which should take into account both the number and site of nodal metastases.     

Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems

BACKGROUND: The pN classification of gastric cancer (GC) in the Japanese system (Japanese Gastric Cancer Association; JGCA) is based on the site and distance of metastatic nodes from the primary tumour. Union International Contra Cancer (UICC) has recently proposed a classification system based on the number of nodes involved (TNM-1997). The aim of the present study is to assess which classification system is more suitable for providing a prognosis in advanced GC with lymph node metastasis. METHODS: A total of 224 patients who underwent curative gastrectomy (R0: UICC-TNM and Resection A and B: JGCA) and D2 lymphadenectomy between 1990 and 1999, and diagnosed as pT2, pT3 and pT4 GC were enrolled. Patients were followed until the end of 2002. The disease-free survival rates of patients were compared between the two-stage systems (UICC-TNM and JGCA). RESULTS: Using the JGCA system, there was a significant difference between the two survival curves (pN0 and pN1, P = 0.025; pN1 and pN2, P < 0.001; pN2 and pN3, P = 0.031), but the 5-year survival rate of 27 pN2 patients (32.7%) was not significantly different from that of 14 pN3 patients (34.3%, P = 0.994) using the UICC-TNM. In 47 patients with JGCA pN2, the 5-year survival rate of 18 patients with UICC-TNM pN1 (42.9%) was not significantly different from that of 18 patients with UICC-TNM pN2 (25.2%, P = 0.422) or from that of 11 patients with UICC-TNM pN3 (24.2%; P = 0.383). CONCLUSIONS: The JGCA system is more suitable for estimating the prognosis of Japanese patients with advanced GC than the UICC-TNM.     

Three-field lymphadenectomy and pattern of lymph node spread in T3 adenocarcinoma of the distal esophagus and the gastro-esophageal junction

Objective: Lymph node metastasis in carcinoma of the esophagus and the gastro-esophageal junction is often underestimated by clinical staging. It is the aim of this study to provide support to the fact that three-field lymphadenectomy leads to a better pathological staging also in adenocarcinoma. Methods: The pattern of lymph node metastasis in adenocarcinoma of the gastro-esophageal junction (GEJ) and the distal esophagus was charted in a prospective way by using a database. An analysis was performed with regard to lymphatic spread in T₃, N⁺ adenocarcinomas of the distal esophagus and the GEJ junction, which were treated with a radical resection including a three-field lymphadenectomy. Out of 324 patients with adenocarcinoma of the esophagus and GEJ, we selected a group of 37 patients with an adenocarcinoma T₃, N⁺ of the distal (n=17) or GEJ junction (n=20), treated with a radical resection and three-field lymphadenectomy (>25 lymph nodes resected). Results: In total, 2240 lymph nodes were removed, with a mean of 59.5 per patient. In the GEJ group the ratio of positive nodes was 15.9, in the distal 1/3 group this ratio was 12.7%. Abdominal lymph nodes were positive in all GEJ tumors and in 70% of the distal third carcinomas. Thoracic lymph nodes were positive in 40% of GEJ tumors, and 70.6% of the distal group. Cervical lymph nodes were positive in 20% of the GEJ tumors and in 35.3% of the distal tumors. In six patients only right-sided cervical nodes were affected. Three patients in the GEJ group had positive lymph nodes in the neck without any involvement of thoracic lymph nodes. Conclusions: (1) Three-field lymphadenectomy improves accuracy of staging. (2) Cervical nodes are frequently involved. (3) Especially in tumors of the GEJ there is an important skipping phenomenon, i.e. positive lymph nodes in the neck in the absence of involvement of thoracic nodes. (4) Clinical staging remains deficient in regard to lymph node metastasis, especially cervical nodes. (5) The frequent unforeseen involvement of cervical lymph nodes in adenocarcinoma of the distal esophagus and GEJ tumors makes the interpretation of results of induction chemoradiotherapy questionable. (6) For the same reason, cervical lymph nodes should be included in the radiation field in case of induction chemoradiotherapy. (7) The similar pattern of lymph node involvement suggests similar oncological behavior of adenocarcinoma of the distal esophagus and the GEJ, questioning the actual TNM classification of these tumors as gastric carcinomas.     

Accurate Lymph Node Staging is of Greater Prognostic Importance Than Subclassification of the T2 Category for Gastric Adenocarcinoma

Background: Examination of 15 or more lymph nodes is necessary for accurate staging of gastric adenocarcinoma. This study examined whether prognostic discrimination is improved by distinguishing between pT2 tumors limited to the muscularis propria (MP) and those extending to subserosa (SS).Methods: A single-institution, prospectively maintained database for 1985–2000 was reviewed for patients who had had R0 resection of pT2 gastric carcinoma.Results: There were 161 patients with MP and 201 patients with SS. The prevalence of nodal metastasis was significantly lower with MP than with SS (47% vs. 66%, respectively; P < .001). As compared with MP, SS was associated with a similar prevalence of pN1 (44% vs. 43%) but a significantly higher prevalence of pN2 or pN3 (3% vs. 23%; P < .001). Five-year survival was significantly greater for patients with MP than with SS (64% vs. 49%; P = .005). On multivariate analyses, however, only the pN category and tumor site were independently significant prognostic factors. With accurate nodal staging, patients with MP or SS had similar survival in association with pN0 (90% vs. 86%) or pN1 (56% vs. 44%). pN2 or pN3 were mainly limited to SS tumors and these patients had poor survival (26% and 0%).Conclusions: For pT2 gastric adenocarcinoma, the depth of mural invasion was not an independently significant prognostic factor.     

Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction

BACKGROUND: Endoscopic ultrasound (EUS) is the most accurate locoregional staging tool for gastroesophageal junction (GEJ) adenocarcinoma, and it may allow pretreatment risk stratification. The purpose of this study was to compare preoperative EUS staging with postoperative pathologic staging and to assess the ability of EUS to predict survival after resection for GEJ adenocarcinoma. STUDY DESIGN: Patients with GEJ adenocarcinoma, who had preoperative staging with EUS followed by resection, were identified from a prospectively maintained database. Patients receiving neoadjuvant therapy were excluded. EUS stage was compared with pathologic stage. Survival analyses were performed in patients who underwent complete gross resection. RESULTS: From 1985 through 2003, 209 patients underwent preoperative EUS followed by surgery without neoadjuvant therapy for GEJ adenocarcinoma. EUS correlated with pathologic T stage in 128 of 209 (61%) patients and with pathologic nodal stage in 154 of 206 (75%) patients. EUS accurately stratified patients into "early" (T0-2 N0) or "advanced" (T3-4 or N1) disease categories in 173 (83%) patients. Curative (R0) resection was performed in 184 patients: EUS "early" (n=84) and "advanced" (n=122) stages were associated with R0 rates of 100% and 82%, respectively (p=0.001). EUS "early" versus "advanced" stage was highly predictive of outcomes (p < 0.0001). The 5-year disease-specific survival for EUS "early" patients was 65% compared with 34% for EUS "advanced" stage. CONCLUSIONS: EUS accurately predicts pathologic stage. In addition, EUS is predictive of outcomes after complete gross resection without neoadjuvant treatment for GEJ adenocarcinoma and identifies a high-risk population that might benefit from preoperative therapy.     

淋巴结转移率对食管胃交界部腺癌患者的预后评估价值

目的 比较AJCC/UICC胃癌淋巴结（pN）分期与淋巴结转移率（MLR）分期及以其为基础的TNM与TRM分期系统对食管胃交界部腺癌患者的预后评估价值.方法 回顾性分析天津市肿瘤医院2000年1月至2007年6月间行根治性切除手术的414例食管胃交界部腺癌的临床资料.采用Spearman相关分析检验 pN、MLR与送检淋巴结数3者之间的相关性;应用单因素KaplanMeier生存分析和多因素Cox回归分析检验pN、MLR、TNM及TRM分期与患者预后的关系;通过ROC曲线下面积（AUC）比较它们对患者5年生存率的预测价值.结果 414例患者中位淋巴结清扫数目17（4～71）枚/例,中位转移淋巴结数目4（0～67）枚/例.阳性淋巴结数与淋巴结清扫数目呈正相关 （P＜0.01）,MLR与淋巴结清扫数目无相关性（P＞0.05）.单因素和多因素预后分析结果表明,pN和MLR均可单独作为食管胃交界部腺癌患者的独立预后因素（均P＜0.01）,且MLR的相对危险度（HR）值高于pN（1.573比1.382）;但当pN与MLR共同纳入多因素分析时,MLR仍是独立预后因素（P＜0.01）,而pN不再是其独立预后因素（P＞0.05）.MLR和pN预测患者预后所对应的AUC分别为0.726和 0.714,TRM分期和TNM分期所对应的AUC分别为0.747和0.736,差异均无统计学意义（均P＞0.05）.结论 MLR是食管胃交界部腺癌患者的独立预后因素,MLR及以其为基础的TRM分期对食管胃交界部腺癌患者预后的评估价值或优于pN及以其为基础的TNM分期.     

Adenocarcinoma of the Duodenum: Importance of Accurate Lymph Node Staging and Similarity in Outcome to Gastric Cancer

Background: This study examined prognostic discrimination by lymph node staging for duodenal adenocarcinoma and compared the nodal stage–specific survival with that associated with gastric antral adenocarcinoma.Method: Prospectively maintained databases from 1983 to 2000 were reviewed to identify 137 patients with duodenal adenocarcinoma and 545 patients with gastric antral adenocarcinoma at a single institution.Results: R0 resection was performed for 72 patients with duodenal cancer. At least 15 lymph nodes were retrieved in 34 cases (47%). Lymph node metastasis (pN⁺) was detected in 31 patients (43%). With median follow-up of 36 months, the pN category was an independently significant prognostic factor (pN0, 5-year disease-specific survival of 83%, vs. pN⁺, 56%; P = .03). The survival difference between pN0 and pN⁺ was pronounced in patients with 15 nodes (100% vs. 47%, respectively; P = .01) but was lost in those with <15 nodes (75% vs. 64%; P = .5). For gastric antrum cancer, 331 patients had R0 resection, and 15 nodes were retrieved in 256 cases (77%). Lymph node metastasis was detected in 157 cases (47%). For patients with 15 nodes, 5-year survival with pN0 (87%) or pN⁺ (44%) was not significantly different from the corresponding categories for duodenal adenocarcinoma.Conclusion: For duodenal adenocarcinoma, examination of 15 regional lymph nodes improved prognostic discrimination by the pN category. With accurate nodal staging, pN0 was associated with excellent prognosis. With pN⁺, prognosis was similar to that for gastric antral adenocarcinoma.     

一种新的胃癌淋巴结分期方案

目的比较AJCC/UICC 1997年第五版胃癌TNM分期中的N分期与以淋巴结转移度为标准的新N分期. 方法行D2或D3术式的胃癌(皆无远处转移)标本用透光法摘取淋巴结,分别按2种方法分期,新法中N1为淋巴结转移度0.01%～10.00%, N2为10.01%～25.00%,N3为＞25.00%.全组随访,资料经统计学处理. 结果本组78例患者共取得淋巴结5388 枚,平均每例69枚(范围30～157枚).全组淋巴结转移率75.64%(59/78).新分期N0、N 1、N2、N3期患者3年生存率分别为100%、68.42%、7.58%、6.78%(χ2=35.85 0,P<0.01, r=0.95). 结论淋巴结转移度是一相对数,在预后的判断上,优于淋巴结转移数目.     

A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer

Background

Our aim was to establish a new pN staging system for gastric cancer based on the number and location of metastatic lymph nodes (MLNs) and to compare it with other systems.

Methods

We retrospectively analyzed the prognostic data of 521 gastric cancer patients who underwent curative resection. Survival analyses were used to establish a pN staging system that considers both the number and location of MLNs and to compare discriminatory ability and monotonicity of gradients (linear trend χ ² score), homogeneity ability (likelihood ratio test), and prognostic stratification ability (Akaike information criterion) between Japanese Gastric Cancer Association (JGCA) and Union for International Cancer Control (UICC) systems.

Results

Cut-point survival analysis divided pN⁺ patients into two groups: Nxn_1~6 and Nxn_≥7. N0, N1, N2, and N3 (the previous classifications) were replaced by N0, N1n_1~6, N2n_1~6, and N1n_≥7 + N2n_≥7 + N3n_1~6 + N3n_≥7, respectively. Compared with two widely used staging systems, the new system had the highest likelihood ratio test [106.06 (new) vs 95.09 (JGCA) vs 94.33 (UICC)] and linear trend χ ² scores [102.30 (new) vs 89.12 (JGCA) vs 86.97(UICC)] and the lowest Akaike information criterion (AIC) score [2,283.88 (new) vs 2,285.31 (JGCA) vs 2,299.88 (UICC)].

Conclusion

A new pN staging system based on the number and location of MLNs is an efficient prognostic indicator of the survival of patients with gastric cancer following radical surgery.     

Old and new TNM in carcinoma of the gastric antrum: Analysis of our personal experience

Various tumor node metastasis (TNM) classifications have been proposed for staging of gastric carcinoma, including the fourth edition of the TNM classification and the Japanese Research Society for Gastric Cancer (JRSGC) system. In 1997 the fifth edition of TNM classification introduced the concept of the number of metastatic lymph nodes. We review our experience with staging gastric cancer in light of both the fourth and fifth editions of the TNM classification system. From January 1986 to December 1997, we performed subtotal resection in 193 patients with carcinoma of the gastric antrum. A total of 147 patients presented with criteria from the fifth TNM edition. We compared data from these patients with data from the fourth TNM edition. We analyzed 84 females and 63 males whose average age was 68.9 years. The average number of lymph nodes removed was 16.7. We used the Kaplan-Meier method to analyze survival. In accordance with the fourth TNM edition, we recorded 82 patients who were pN0, 36 who were pN1, and 29 who were pN2; according to the fifth edition, 82 patients were pN0, 3 3 were pN1, 17 were pN2, and 15 were pN3. Average follow-up was 26.7 months, and average survival was 56.9 months for N0 patients, 38.7 months for N1 patients, and 24.5 months for N2 patients staged according to the fourth edition. According to the fifth edition, survival was 39.3 months for N1 patients, 33.6 months for N2 patients, and 10.3 months for N3 patients. The survival curve was statistically different (P < 0.001) between N0 and N1 patients according to the fourth edition; there was no significant difference between N1 and N2 patients. According to the fifth edition, the difference in survival probability was P < 0.001 between N0 and N1 patients and N2 and N3 patients. The fifth TNM edition presents a greater ease of stratification in bringing together and mediating diverse cultural experiences between West and East. This staging lays the basis for a more accurate comparison between the groups.     

Lymph node density vs. the American Joint Committee on Cancer TNM nodal staging system in node-positive bladder cancer in patients undergoing extended or super-extended pelvic lymphadenectomy

Purpose

We compared the prognostic value of the American Joint Committee on Cancer (AJCC) TNM nodal staging system with that of lymph node (LN) density in patients with LN-positive bladder cancer who received extended or super-extended pelvic lymphadenectomy.

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??Prognostic factors for long-term survival in patients with pancreatic adenocarcinoma and evaluation of 8th AJCC staging??A report of 143 cases LI Ji-song??TIAN Xiao-dong??GAO Hong-qiao, et al. Department of General Surgery??Peking University First Hospital??Beijing 100034??China
Corresponding author??YANG Yin-mo??E-mail??yangyinmo@263.net
Abstract Objective To analyze clinicopathological factors influencing the prognosis of the patients with resectable pancreatic ductal adenocarcinoma (PDAC) and evaluate the 8th AJCC TNM staging. Methods A total of 143 cases of PDAC underwent resection in Department of General Surgery of Peking University First Hospital from January 2010 to December 2016. The clinical and survival data were analyzed retrospectively for prognostic factors. Results A total of 100 patients (69.9%) with pancreatic head carcinoma underwent pancreatoduodenectomy, while 43 patients (30.1%) with tumors located in the pancreatic body/tail underwent distal pancreatectomy or total pancreatectomy. Multivisceral resections were performed in 10 patients (7.0%). R0 margins were achieved in 55 patients (38.5%). The percentage of R1 and R2 resections were 58.7% and 2.8%, respectively. A total of 75 patients (52.4%) received adjuvant chemotherapy. The median overall survival (OS) time was 20 (95%CI 17.5-22.5) months and disease-free survival (DFS) time was 14 (95%CI 12.5-15.5) months. Univariate and multivariate analysis revealed that AJCC T staging, N staging, R2 resection margin status, low- or un-differentiated grade, vascular resection, neutrophil-to-lymphocyte ratio (NLR) ≥2, CA19-9≥400 U/mL and adjuvant chemotherapy were prognostic factors??P<0.05??. The 8th AJCC TNM staging was significantly associated with prognosis. Conclusion TNM staging system could predict prognosis accurately on the basis of adequate examined lymph nodes. R0/R1 resection and adjuvant chemotherapy could improve the survival of the patients significantly.     

Valor pronóstico del ratio nodal en el cáncer gástrico: análisis unicéntrico de 199 pacientes

IntroductionIn the gastric cancer the most widely used classification is the AJCC TNM system. However, it presents limitations, such as staging migration in cases with suboptimal lymphadenectomies. The nodal ratio has been proposed as an alternative system, proving to be a good prognostic predictor of survival. The aim was to assess the influence of the nodal ratio measured in tertiles [tNR] as a prognostic factor and compare with the TNM systems (7th ed.) and log odds of positive lymph nodes [LODDS].Material and methodsRetrospective and single-center study on 199 patients operated on with curative intent between 2010 and 2014. For each system an univariate and multivariate analysis was performed and the overall survival rates [OS] were compared by the ROC test.ResultsThe prognostic factors that showed statistical significance in the multivariate analysis were: tNR2 (HR 2.87) and tNR 3 (HR 7.29); LODDS 2 (HR 1.55), LODDS3 (HR 2.6) and LODDS4 (HR 4.9); pN2 (HR 1.84) and pN3 (HR 2.91). The 5-year OS was 75.8, 61.4, 25.8 and 3.84% for tNR0, tNR1, tNR2 and tNR3; 72.4, 60, 29.1 and 13.9% for LODDS1, LODDS2, LODDS3 and LODDS4; and 77.6, 59.4, 28.8 and 25.5% for pN0, pN1, pN2 and pN3, respectively. The three systems behaved as good predictors, with areas under the curve >0.75.ConclusiontNR was an independent prognostic factor for estimating survival in gastric cancer. Furthermore, the ease of its calculation in clinical practice could reduce the effect of staging migration.     

基于淋巴结分期评分的胰腺癌手术淋巴结清扫数目探讨（附四中心临床研究结果）

目的 探讨胰腺癌淋巴结准确分期所需清扫的淋巴结数目。方法 回顾性分析美国SEER数据库中3989例切除的胰腺癌淋巴结阳性病人资料并进行建模，得到淋巴结分期评分达到90%时所需的淋巴结清扫数目作为推荐值，并利用SEER数据库2583例与国内93例淋巴结阴性病人进行生存分析验证结果。结果 肿瘤最大径＜2 cm是胰腺癌淋巴结清扫数量的影响因素。预期对阴性结果达到90%把握时，肿瘤最大径＜2 cm的病人需要活检15枚淋巴结，而≥2 cm的病人需要活检20枚。校正假阴性病人后，淋巴结阳性率从60.7%升至71.0%。生存分析提示肿瘤最大径≥2 cm病人中，淋巴结分期评分与生存有相关性（P=0.002）。结论 肿瘤最大径是决定胰腺癌淋巴结清扫数量的因素。根据淋巴结分期评分，推荐清扫更多淋巴结。     

Lymph node-positive bladder cancer treated with radical cystectomy and lymphadenectomy: effect of the level of node positivity

Background

The extent of lymphadenectomy needed to optimize oncologic outcomes after radical cystectomy (RC) for patients with regionally advanced bladder cancer (BCa) is unclear.

Objective

Evaluate the effect of the location of lymph node metastasis on recurrence-free survival (RFS) and cancer-specific survival (CSS) for patients undergoing RC with a mapping pelvic lymph node dissection (PLND).

Design, setting, and participants

A study of 591 patients undergoing RC with mapping PLND was completed between 2000 and 2010. Median follow-up was 30 mo.

Intervention

RC with mapping PLND.

Measurements

We evaluated the impact of lymph node involvement by location on disease outcomes using the 2010 TNM staging system. Survival estimates were described using Kaplan-Meier methods. Gender, age, pathologic stage, histology, number of positive nodes, location of positive nodes, node density, use of perioperative chemotherapy, and grade were evaluated as predictors of RFS and CSS using multivariate Cox proportional hazard regression.

Results and limitations

Overall, 114 patients (19%) had lymph node involvement, and 42 patients (7%) had pN3 disease. On multivariate analysis, the number of positive lymph nodes (one or two or more) was significantly associated with increased risk of cancer-specific death (hazard ratio [HR]: 1.9 [95% confidence interval (CI), 1.04–3.46], p = 0.036; versus HR: 4.3 [95% CI, 2.25–8.34], p < 0.0005). Positive lymph node location was not an independent predictor of RFS or CSS. Five-year RFS for pN3 patients undergoing RC with PLND was 25% (95% CI, 10–42). This finding was not statistically different from our pN1 and pN2 patients (38% [95% CI, 22–54] and 35% [95% CI, 11–60], respectively). This study is limited by the lack of prospective randomization and a control group.

Conclusions

The outcome for patients with involved common iliac lymph nodes was similar to the outcome for patients with primary nodal basin disease. These data support inclusion of the common iliac lymph nodes (pN3) in the nodal staging system for BCa. Lymph node location was not an independent predictor of outcome, whereas the number of positive lymph nodes was an independent predictor of worse oncologic outcome (pN1, pN2). Further refinements of the TNM system to provide improved prognostication are warranted.     

Pathologic nodal downstaging in men with clinically involved lymph nodes undergoing radical prostatectomy: Implications for definitive locoregional therapy

A prostate cancer (CaP) patient with nonmetastatic but clinical positive lymph nodes (cN+) represents a difficult clinical scenario. We compare overall survival (OS) between cN+ men that underwent radical prostatectomy (RP) and were found to have negative node status (pN) with those found to have positive nodal status (pN+), and assess predictors of discordant nodal status. We queried the National Cancer Data Base between 2004 and 2015 for patients that were cT1-3 cN+ cM0 CaP treated with RP. Patients with 0 nodes, cT4, or cM1 disease were excluded. We compared groups based on pathologic nodal status: Discordant (cN+ -> pN) & Concordant (cN+ -> pN+). Kaplan Meier estimations were used to compare OS. Logistic regression was used to determine possible predictors of nodal status. We find that of 6470 cN+ patients, 1,367 (21.1%) underwent RP, 866 (13.4%) had confirmed nodal status. Discordant status was found in 159 (18.4%) and concordant staging in 707 (81.6%). Differences exist in PSA at diagnosis (7.3 vs. 11.2), biopsy group, # of nodes examined (7 vs. 10), race, and Charlson index. Discordant staging had longer OS compared to Concordant staging (P = 0.007) and similar OS to a 3:1 matched cohort of high risk localized CaP patients used as reference (P = 0.46). Lower Gleason Score (GG1-3) was associated with an increased likelihood of discordant staging. Clinical nodal staging is associated with a substantial false positive rate. Discordant status had better OS than Concordant status and similar OS to matched patients with localized CaP. Clinical nodal staging may inappropriately lead to noncurative therapy in a substantial number of men with potentially curable disease.