Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Urology. 2011 Feb;77(2):402-6. doi: 10.1016/j.urology.2010.05.015. Epub 2010 Aug 16.
Controversy persists regarding the adequacy of pelvic lymph node dissection (PLND) and cancer control when comparing minimally invasive radical prostatectomy (MIRP) and open radical prostatectomy (RRP). We characterized determinants of performance and extent of PLND during radical prostatectomy in elderly men.
A population-based study was conducted comprised of 5448 men ≥65 years undergoing RRP and MIRP during 2004 to 2006 from Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data. Multivariable logistic regression was used to assess the effect of demographic and tumor characteristics, surgical approach, and surgeon volume on the likelihood of performing PLND.
PLND was performed for 87.6% vs. 38.3% of men undergoing RRP vs. MIRP (P <.001). Among RRP, 82.6% vs. 4.6% underwent extended vs. limited PLND, with a median yield of 4 vs. 3 lymph nodes (P <.001). Median MIRP PLND yield was 3 lymph nodes. In adjusted analyses, men undergoing RRP vs. MIRP (odds ratio [OR] 16.7; 95% confidence interval [CI], 11.1-25.0), those with few vs. multiple comorbidities (OR 1.4, 95% CI 1.02-1.91), intermediate (OR 1.87; 95% CI 1.48-2.37), and high (OR 2.77; 95% CI 2.02-3.78) vs. low-risk features, and men treated by high-volume surgeons (OR 1.008; 95% CI 1.004-1.011) were more likely to undergo PLND. Conversely, Hispanic (OR 0.68, 95% CI 0.49-0.96) vs. white men were less likely to undergo PLND.
Independent of tumor characteristics, men undergoing RRP vs. MIRP were more likely to undergo PLND with greater lymph node yield and racial variation observed. Further studies are needed to determine the appropriate use of PLND.
在比较微创根治性前列腺切除术（MIRP）和开放性根治性前列腺切除术（RRP）时，关于盆腔淋巴结清扫术（PLND）的充分性和癌症控制效果仍存在争议。我们描述了在老年男性接受根治性前列腺切除术时 PLND 的实施和范围的决定因素。
这是一项基于人群的研究，纳入了 2004 年至 2006 年期间，接受 RRP 和 MIRP 的 5448 名年龄≥65 岁的男性，数据来源于监测、流行病学和最终结果（SEER）-医疗保险链接数据库。采用多变量逻辑回归评估人口统计学和肿瘤特征、手术方式以及外科医生手术量对行 PLND 的可能性的影响。
RRP 中，87.6%的患者 vs. MIRP 中 38.3%的患者行 PLND（P<0.001）。在 RRP 中，82.6%的患者 vs. 4.6%的患者行广泛 PLND 与有限 PLND，中位淋巴结清扫数分别为 4 枚 vs. 3 枚（P<0.001）。MIRP 的中位 PLND 淋巴结清扫数为 3 枚。在调整后的分析中，与 MIRP 相比，RRP（比值比 [OR] 16.7；95%置信区间 [CI] 11.1-25.0）、合并症较少（OR 1.4，95%CI 1.02-1.91）、中等（OR 1.87；95%CI 1.48-2.37）和高危（OR 2.77；95%CI 2.02-3.78）特征的患者，以及由高手术量医生治疗的患者（OR 1.008；95%CI 1.004-1.011）更有可能行 PLND。相反，与白人相比，西班牙裔（OR 0.68，95%CI 0.49-0.96）患者更不可能行 PLND。
无论肿瘤特征如何，RRP 患者比 MIRP 患者更有可能接受 PLND，且前者的淋巴结清扫范围更大，并且观察到种族差异。需要进一步研究来确定 PLND 的适当应用。
