Allaf Mohamad E, Palapattu Ganesh S, Trock Bruce J, Carter H Ballentine, Walsh Patrick C
Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Urol. 2004 Nov;172(5 Pt 1):1840-4. doi: 10.1097/01.ju.0000140912.45821.1d.
This study evaluates the influence of the anatomical extent of pelvic lymph node dissection performed at radical prostatectomy on lymph node yield, staging accuracy and time to prostate specific antigen progression.
Between February 1992 and April 2003, 2 surgeons at 1 hospital performed 2,135 and 1,865 radical prostatectomies with pelvic lymph node dissection, respectively. One surgeon routinely performed an extended lymph node dissection while the second surgeon performed a limited pelvic lymphadenectomy. The number of lymph nodes extracted and the number of patients with positive lymph nodes detected were analyzed and compared. Kaplan-Meier analysis was used to compare the biochemical recurrence-free survival between the 2 groups of patients with occult nodal disease.
Extended lymph node dissection removed more lymph nodes (mean 11.6 vs 8.9, p<0.0001) and detected more lymph node positive disease (3.2% vs 1.1%, p<0.0001) than the more anatomically limited technique. This finding held true for patients across all pathology groups. Among men with lymph node positive disease involving less than 15% of extracted nodes, the 5-year prostate specific antigen progression-free rate for extended lymph node dissection was 43% versus 10% for the more limited lymph node dissection (p = 0.01).
Compared to limited lymph node dissection, extended pelvic lymphadenectomy appears to identify men with positive lymph nodes more frequently. A significant benefit in biochemical recurrence-free survival may exist for certain subgroups undergoing the extended dissection. However, because the results may be influenced by stage migration, longer followup is necessary to determine whether the apparent therapeutic effect persists.
本研究评估根治性前列腺切除术中盆腔淋巴结清扫的解剖范围对淋巴结获取量、分期准确性及前列腺特异性抗原进展时间的影响。
1992年2月至2003年4月期间，一家医院的2名外科医生分别实施了2135例和1865例伴有盆腔淋巴结清扫的根治性前列腺切除术。一名外科医生常规进行扩大淋巴结清扫，另一名外科医生进行有限的盆腔淋巴结切除术。分析并比较提取的淋巴结数量及检测出的淋巴结阳性患者数量。采用Kaplan-Meier分析比较两组隐匿性淋巴结疾病患者的无生化复发生存率。
与解剖范围更有限的技术相比，扩大淋巴结清扫切除的淋巴结更多（平均11.6个对8.9个，p<0.0001），检测到的淋巴结阳性疾病更多（3.2%对1.1%，p<0.0001）。这一发现适用于所有病理组的患者。在淋巴结阳性疾病累及提取淋巴结不到15%的男性中，扩大淋巴结清扫的5年无前列腺特异性抗原进展率为43%，而更有限的淋巴结清扫为10%（p = 0.01）。
与有限淋巴结清扫相比，扩大盆腔淋巴结切除术似乎更频繁地识别出淋巴结阳性男性。对于某些接受扩大清扫的亚组患者，在无生化复发生存方面可能存在显著益处。然而，由于结果可能受分期迁移影响，需要更长时间的随访来确定明显的治疗效果是否持续存在。
