Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Urol. 2010 Jul;184(1):143-8. doi: 10.1016/j.juro.2010.03.039. Epub 2010 May 15.
We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy.
Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method.
A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes.
Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal.
我们评估了根治性前列腺切除术后淋巴结转移患者无生化复发的预测因素。
在 207 例接受根治性前列腺切除术和双侧盆腔淋巴结清扫术的淋巴结转移患者中，45 例接受辅助雄激素剥夺治疗，162 例未接受治疗。采用 Cox 比例风险回归模型探讨根治性前列腺切除术后生化复发的预测因素。使用 Kaplan-Meier 方法估计生化复发的概率。
中位切除淋巴结数为 13 枚。122 例患者有 1 枚淋巴结阳性，44 例有 2 枚，41 例有 3 枚或更多阳性淋巴结。未接受雄激素剥夺治疗的患者中，103 例有 1 枚淋巴结阳性，35 例有 2 枚，24 例有 3 枚或更多阳性淋巴结，69 例发生生化复发。1 枚、2 枚和 3 枚或更多阳性淋巴结患者的中位复发时间分别为 59、13 和 3 个月。仅标本 Gleason 评分和阳性淋巴结数量是生化复发的独立预测因素。无雄激素剥夺治疗的患者中，1 枚阳性淋巴结和前列腺癌 Gleason 评分 7 或更低的患者，2 年无生化复发的概率为 79%，而 Gleason 评分 8 或更高和 2 枚或更多阳性淋巴结的患者为 29%。
淋巴结转移患者的预后取决于阳性淋巴结的数量和原发肿瘤 Gleason 分级。所有淋巴结转移患者中，80%有 1 枚或 2 枚阳性淋巴结。这些患者中有很大一部分预后良好。对于中高危癌症患者，应行双侧全盆腔淋巴结清扫术，以识别可能受益于转移性淋巴结切除的患者。
