Petros J A, Catalona W J
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
J Urol. 1992 Jun;147(6):1574-5. doi: 10.1016/s0022-5347(17)37630-9.
Between 1983 and 1991 we saw 521 consecutive patients who elected to undergo radical prostatectomy for clinically localized prostatic carcinoma. We performed staging pelvic lymphadenectomy to avoid radical prostatectomy in patients with pelvic lymph node metastases who would be unlikely to be cured by the operation. However, we found that significantly fewer patients had lymph node metastases than historical reports would have led us to predict. Of 32 patients with clinical stage A1 disease none had positive nodes, compared to 2 of 61 (3.3%) with stage A2, 10 of 189 (5.3%) with stage B1 and 23 of 236 (9.7%) with stage B2 disease. We conclude that this lower incidence of nodal involvement relative to previous reports reflects a true change in the stage at which prostate cancer currently is diagnosed. We postulate that a higher index of suspicion, earlier detection, more aggressive intervention to establish the diagnosis, use of ultrasound guided prostate biopsies and more widespread screening for prostate cancer contribute to the lower incidence of occult lymph node metastases in patients with clinically localized prostate cancer.
在1983年至1991年间，我们连续观察了521例因临床局限性前列腺癌而选择接受根治性前列腺切除术的患者。我们进行分期盆腔淋巴结清扫术，以避免对盆腔淋巴结转移且手术不太可能治愈的患者进行根治性前列腺切除术。然而，我们发现发生淋巴结转移的患者明显少于既往报告让我们预测的数量。32例临床A1期疾病患者中无淋巴结阳性，相比之下，61例A2期患者中有2例（3.3%），189例B1期患者中有10例（5.3%），236例B2期患者中有23例（9.7%）。我们得出结论，相对于既往报告，这种淋巴结受累发生率较低反映了目前前列腺癌诊断阶段的真实变化。我们推测，更高的怀疑指数、更早的检测、更积极的诊断干预、超声引导下前列腺活检的使用以及更广泛的前列腺癌筛查，导致临床局限性前列腺癌患者隐匿性淋巴结转移的发生率降低。
