Meng M V, Carroll P R
Department of Urology, University of California San Francisco and Program in Urologic Oncology, University of California San Francisco-Mt. Zion Cancer Center, San Francisco, California, USA.
J Urol. 2000 Oct;164(4):1235-40.
In recent years the role of pelvic lymph node dissection before or at radical prostatectomy has been questioned. We compared the outcome of performing or omitting pelvic lymph node dissection in patients undergoing radical retropubic prostatectomy by formal decision analysis.
We created a decision tree for patients undergoing radical retropubic prostatectomy that accounts for all possible branch points and outcomes. Outcome probabilities applied to the model were derived from published data. Utility values were determined for each outcome state by a panel of experts. Decision analysis was done using decision analysis computer software. Sensitivity analysis was performed to determine which elements in the model were most important and to calculate threshold values.
Using probability data from the literature and our assigned outcome values, decision analysis initially favored omitting pelvic lymph node dissection. Sensitivity analysis revealed that the threshold values for the incidence of positive lymph nodes and the sensitivity of lymph node dissection and frozen section analysis at which outcomes were equivalent were 18% and 80%, respectively. Analysis was insensitive to the pelvic lymph node dissection complication rate.
We performed formal decision analysis to determine the incidence of lymph node metastasis below which pelvic lymph node dissection is not warranted at radical retropubic prostatectomy. Our results suggest that lymph node dissection is unnecessary in the subset of patients in which the risk of lymph node involvement is less than 18%.
近年来，前列腺癌根治术前或术中盆腔淋巴结清扫术的作用受到质疑。我们通过正式的决策分析，比较了接受耻骨后前列腺癌根治术的患者进行或不进行盆腔淋巴结清扫术的结果。
我们为接受耻骨后前列腺癌根治术的患者创建了一个决策树，该决策树考虑了所有可能的分支点和结果。应用于该模型的结果概率来自已发表的数据。由专家小组确定每个结果状态的效用值。使用决策分析计算机软件进行决策分析。进行敏感性分析以确定模型中哪些因素最重要，并计算阈值。
根据文献中的概率数据和我们指定的结果值，决策分析最初倾向于不进行盆腔淋巴结清扫术。敏感性分析显示，淋巴结阳性发生率以及淋巴结清扫术和冰冻切片分析的敏感性在结果相等时的阈值分别为18%和80%。分析对盆腔淋巴结清扫术的并发症发生率不敏感。
我们进行了正式的决策分析，以确定淋巴结转移的发生率，低于该发生率时，耻骨后前列腺癌根治术中无需进行盆腔淋巴结清扫术。我们的结果表明，在淋巴结受累风险小于18%的患者亚组中，淋巴结清扫术是不必要的。
