Weckermann Dorothea, Dorn Robert, Trefz M, Wagner Theodor, Wawroschek Friedhelm, Harzmann Rolf
Department of Urology, Klinikum Augsburg, Augsburg, Germany.
J Urol. 2007 Mar;177(3):916-20. doi: 10.1016/j.juro.2006.10.074.
We determined the incidence of positive pelvic lymph nodes in men undergoing radical retropubic prostatectomy and describe the correlation with prostate specific antigen, histological grade and stage. We examined whether tumor cells are localized in the sentinel nodes only or also in other nonsentinel lymph nodes.
A total of 1,055 men with prostate cancer underwent radio guided pelvic lymph node dissection and radical retropubic prostatectomy. In men with prostate specific antigen 20 ng/ml or less and biopsy Gleason score 7 or less only sentinel nodes were removed. In men with prostate specific antigen more than 20 ng/ml or Gleason score greater than 7 extended pelvic lymph node dissection was also performed.
Positive lymph nodes were found in 207 men (19.6%). In 63.3% of the men these lymph nodes were detected outside of the region of standard lymphadenectomy. The percent of patients with positive nodes was greater than predicted by currently used nomograms. The higher the preoperative prostate specific antigen, pathological stage and grade, the greater the percent of men with positive sentinel and nonsentinel lymph nodes (p<0.001).
When deciding on pelvic lymph node dissection, sentinel or extended lymphadenectomy should be performed since more than half of patients have positive nodes outside of the region of standard lymphadenectomy. In cases of positive sentinel nodes extended lymph node dissection should be performed since tumor cells are also detectable in nonsentinel lymph nodes.
我们确定了接受耻骨后根治性前列腺切除术的男性盆腔淋巴结阳性的发生率，并描述了其与前列腺特异性抗原、组织学分级和分期的相关性。我们研究了肿瘤细胞是否仅局限于前哨淋巴结，还是也存在于其他非前哨淋巴结中。
共有1055例前列腺癌男性患者接受了放射性引导盆腔淋巴结清扫术和耻骨后根治性前列腺切除术。对于前列腺特异性抗原20 ng/ml及以下且活检Gleason评分7分及以下的男性患者，仅切除前哨淋巴结。对于前列腺特异性抗原超过20 ng/ml或Gleason评分大于7分的男性患者，还进行了扩大盆腔淋巴结清扫术。
207例男性患者（19.6%）发现盆腔淋巴结阳性。在这些男性患者中，63.3%的阳性淋巴结是在标准淋巴结清扫区域以外检测到的。淋巴结阳性患者的比例高于目前使用的列线图预测值。术前前列腺特异性抗原、病理分期和分级越高，前哨和非前哨淋巴结阳性的男性患者比例越高（p<0.001）。
在决定是否进行盆腔淋巴结清扫时，应进行前哨或扩大淋巴结清扫，因为超过一半的患者在标准淋巴结清扫区域以外存在阳性淋巴结。在前哨淋巴结阳性的情况下，应进行扩大淋巴结清扫，因为在非前哨淋巴结中也可检测到肿瘤细胞。
