Joslyn Sue A, Konety Badrinath R
Division of Health Promotion and Education, University of Northern Iowa, Cedar Falls, Iowa, USA.
Urology. 2006 Jul;68(1):121-5. doi: 10.1016/j.urology.2006.01.055. Epub 2006 Jun 27.
Controversy exists regarding the benefit of extended lymphadenectomy at radical prostatectomy for prostate cancer. We sought to determine whether more extended lymphadenectomy, along with radical prostatectomy, resulted in a decreased risk of prostate cancer-specific death at 10 years.
Data on all patients undergoing radical prostatectomy (with or without lymphadenectomy) for prostate cancer obtained from the Surveillance, Epidemiology, and End Results Program (1988 to 1991) were examined. All surviving patients had a minimal follow-up of 10 years. Multivariate Cox proportional hazards analysis was used to determine the independent effect of lymphadenectomy on the risk of prostate cancer-specific death.
Patients undergoing excision of at least 4 lymph nodes (node-positive and node-negative patients) or more than 10 nodes (only node-negative patients) had a lower risk of prostate cancer-specific death at 10 years than did those who did not undergo lymphadenectomy. The removal of a greater number of nodes was associated with a greater likelihood of the presence of positive nodes. The presence of more than one positive node was associated with a greater risk of prostate cancer-related death.
Performing more extensive pelvic lymphadenectomy in patients undergoing radical prostatectomy could improve the accuracy of staging and reduce the risk of prostate cancer-specific death in the long term.
对于前列腺癌根治术中扩大淋巴结清扫术的益处存在争议。我们试图确定在前列腺癌根治术基础上，更广泛的淋巴结清扫术是否能降低10年前列腺癌特异性死亡风险。
研究了从监测、流行病学和最终结果计划（1988年至1991年）中获取的所有接受前列腺癌根治术（无论是否进行淋巴结清扫）患者的数据。所有存活患者的最短随访时间为10年。采用多变量Cox比例风险分析来确定淋巴结清扫术对前列腺癌特异性死亡风险的独立影响。
切除至少4个淋巴结的患者（包括淋巴结阳性和阴性患者）或切除超过10个淋巴结的患者（仅淋巴结阴性患者）在10年时前列腺癌特异性死亡风险低于未进行淋巴结清扫的患者。切除更多数量的淋巴结与淋巴结阳性的可能性更大相关。存在一个以上阳性淋巴结与前列腺癌相关死亡风险更高相关。
对接受前列腺癌根治术的患者进行更广泛的盆腔淋巴结清扫术可提高分期的准确性，并长期降低前列腺癌特异性死亡风险。
