Kawakami Jun, Meng Maxwell V, Sadetsky Natalia, Latini David M, Duchane Janeen, Carroll Peter R
Urologic Outcomes Research Group, Program in Urologic Oncology, Department of Urology, University of California-San Francisco Comprehensive Cancer Center, University of California-San Francisco, California 94115-1711, USA.
J Urol. 2006 Oct;176(4 Pt 1):1382-6. doi: 10.1016/j.juro.2006.06.001.
Widespread screening for prostate cancer in the United States has resulted in earlier tumor identification at lower stages. The fewer number of men with lymph node metastases at initial presentation has altered patterns of pelvic lymphadenectomy before definitive treatment. We characterized patterns of pelvic lymphadenectomy in conjunction with radical prostatectomy in a community based cohort.
In the CaPSURE database we identified men undergoing radical prostatectomy. Patients were stratified into 3 clinical risk groups based on serum prostate specific antigen, T stage and pathological grade. We examined temporal trends of pelvic lymphadenectomy and predictors of pelvic lymphadenectomy.
From 1992 to 2004 the proportion of men undergoing pelvic lymphadenectomy in conjunction with radical prostatectomy decreased from 94% to 80%. Overall positive lymph nodes were identified in 0.87%, 2.0% and 7.1% of men in the low, intermediate and high risk groups, respectively. While men with high risk disease continued to undergo pelvic lymphadenectomy at a high rate (greater than 90%), the fraction of men at low and intermediate risk undergoing pelvic lymphadenectomy steadily decreased. Prostate specific antigen, Gleason sum, clinical stage and income were factors associated with pelvic lymphadenectomy. A mean of 5.7 lymph nodes (median 5.0) were removed.
The performance of pelvic lymphadenectomy has decreased in patients at low and intermediate risk, and remained stable in patients at high risk. Further investigation of the role of extended pelvic lymphadenectomy and the potential therapeutic benefits of pelvic lymphadenectomy would better define the contemporary role of pelvic lymphadenectomy and identify appropriate candidates.
在美国，广泛开展的前列腺癌筛查已使肿瘤在更早期阶段被发现。初诊时出现淋巴结转移的男性数量减少，改变了根治性治疗前盆腔淋巴结清扫的模式。我们在一个基于社区的队列中，对与根治性前列腺切除术相关的盆腔淋巴结清扫模式进行了特征描述。
在CaPSURE数据库中，我们确定了接受根治性前列腺切除术的男性。根据血清前列腺特异性抗原、T分期和病理分级，将患者分为3个临床风险组。我们研究了盆腔淋巴结清扫的时间趋势以及盆腔淋巴结清扫的预测因素。
从1992年到2004年，接受根治性前列腺切除术时同时进行盆腔淋巴结清扫的男性比例从94%降至80%。低、中、高风险组中，分别有0.87%、2.0%和7.1%的男性被发现有阳性淋巴结。虽然高危疾病患者继续以较高比例（超过90%）接受盆腔淋巴结清扫，但低风险和中风险男性接受盆腔淋巴结清扫的比例稳步下降。前列腺特异性抗原、Gleason评分、临床分期和收入是与盆腔淋巴结清扫相关的因素。平均切除5.7个淋巴结（中位数为5.0个）。
低风险和中风险患者的盆腔淋巴结清扫率有所下降，而高风险患者保持稳定。进一步研究扩大盆腔淋巴结清扫的作用以及盆腔淋巴结清扫的潜在治疗益处，将更好地明确盆腔淋巴结清扫的当代作用，并确定合适的候选者。
