前列腺癌淋巴结阳性患者行根治性前列腺切除术的生存获益。

Survival benefit of radical prostatectomy in lymph node-positive patients with prostate cancer.

机构信息

Munich Cancer Registry of the Munich Cancer Center, Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany.

出版信息

Eur Urol. 2010 May;57(5):754-61. doi: 10.1016/j.eururo.2009.12.034. Epub 2010 Jan 20.

DOI:10.1016/j.eururo.2009.12.034

PMID:20106588

Abstract

BACKGROUND

Positive lymph node (LN) status is considered a systemic disease state. In prostate cancer, LN-positive diagnosis during pelvic LN dissection (PLND) potentially leads to the abandonment of radical prostatectomy (RP).

OBJECTIVE

To compare the overall survival (OS) and relative survival (RS; as an estimate for cancer-specific survival) in LN-positive patients with or without RP.

DESIGN, SETTING, AND PARTICIPANTS: Between 1988 and 2007, a total of 35 629 men with prostate cancer were identified at the Munich Cancer Registry; of those, 1413 patients had positive LNs.

INTERVENTION

Of these 1413 LN-positive patients, prostatectomy was abandoned in 456 LN-positive patients, whereas 957 underwent RP despite the LN-positive finding.

MEASUREMENTS

Crucial analyses are based on 938 LN-positive patients (688 with RP and 250 without RP) with complete data regarding age, grade, and prostate-specific antigen (PSA). OS (Kaplan-Meier estimates) and RS are presented, and Cox regression analysis was used to show the influence of predictors such as clinical stage, age at surgery, number of positive LNs, PSA level, grade, and extent of surgery.

RESULTS

Median follow-up was 5.6 yr. OS of patients at 5 yr and 10 yr was 84% and 64%, respectively, with RP and was 60% and 28%, respectively, with aborted RP. The RS of patients at 5 yr and 10 yr was 95% and 86%, respectively, with RP and was 70% and 40%, respectively, with abandoned surgery. There was an imbalance, however, in the number of positive LNs: 17.2% with RP had four or more positive nodes versus 28% in the patient group without RP. In the multivariate model, RP was a strong independent predictor of survival (hazard ratio: 2.04 [95% confidence interval, 1.59-2.63; p<0.0001]).

CONCLUSION

LN-positive patients with complete RP had improved survival compared to patients with abandoned RP. These results suggest that RP may have a survival benefit and the abandonment of RP in node-positive cases may not be justified.

摘要

背景

阳性淋巴结（LN）状态被认为是一种全身性疾病状态。在前列腺癌中，骨盆淋巴结清扫术（PLND）期间诊断出 LN 阳性可能导致根治性前列腺切除术（RP）的放弃。

目的

比较 LN 阳性患者接受或不接受 RP 的总生存（OS）和相对生存（RS；作为癌症特异性生存的估计）。

设计、设置和参与者：1988 年至 2007 年间，慕尼黑癌症登记处共确定了 35629 名前列腺癌患者；其中，1413 名患者的淋巴结阳性。

干预

在这 1413 名 LN 阳性患者中，456 名 LN 阳性患者放弃了前列腺切除术，而 957 名 LN 阳性患者尽管发现了 LN 阳性，但仍接受了 RP。

测量

关键分析基于 938 名 LN 阳性患者（688 名接受 RP，250 名未接受 RP），这些患者的年龄、分级和前列腺特异性抗原（PSA）数据完整。报告 OS（Kaplan-Meier 估计）和 RS，并使用 Cox 回归分析显示临床分期、手术时年龄、阳性淋巴结数量、PSA 水平、分级和手术范围等预测因素的影响。

结果

中位随访时间为 5.6 年。接受 RP 的患者在 5 年和 10 年的 OS 分别为 84%和 64%，而放弃 RP 的患者分别为 60%和 28%。接受 RP 的患者在 5 年和 10 年的 RS 分别为 95%和 86%，而放弃手术的患者分别为 70%和 40%。然而，阳性淋巴结的数量存在不平衡：接受 RP 的患者中有 17.2%有 4 个或更多阳性淋巴结，而未接受 RP 的患者中则有 28%。在多变量模型中，RP 是生存的独立强预测因素（风险比：2.04[95%置信区间，1.59-2.63；p<0.0001]）。