Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada.
BJU Int. 2011 Jul;108(2):209-16. doi: 10.1111/j.1464-410X.2010.09805.x. Epub 2010 Nov 2.
• To examine the association between the number of lymph nodes removed in pelvic lymphadenectomy and the risk of prostate cancer death, particularly in low to intermediate risk prostate cancer patients.
• Data on a subset of patients from a population-based case-cohort study was used to assess the effect of lymph node removal on prostate cancer-specific mortality. • The subset included in this report were those 281 patients from the parent study who were treated with prostatectomy and had a pelvic lymph node dissection and for whom we had a record of the number of nodes removed (the sub-cohort) and 41 patients fitting the same criteria who died of their prostate cancer within 10 years (the cases). • Study variables included number of lymph nodes removed, lymph node status, age, pre-treatment PSA, T category, Gleason score and use of hormonal therapy. • We ran a Cox proportional hazards regression analysis that accounted for the study design and allowed us to consider these patient and disease characteristics as potential confounders of the association of interest. • In a secondary analysis, the results were stratified by nodal status.
• The crude hazard ratio (HR), which is a measure of relative risk, was not statistically significantly associated with a reduction in the risk of prostate cancer mortality as the number of lymph nodes removed at PLND increased (HR: 0.97, 95% CI: 0.91-1.03). • None of the variables considered as potential confounders had an impact on the crude HR. Using two cut points to categorize the number of lymph nodes removed, one at 4 or more removed and the other at 10 or more removed resulted in HRs indicating a risk reduction of 25% in both cases, although these results were not statistically significant. • When we analyzed the association by pathological nodal status, we observed a possible increase in risk in the node-positive group (HR: 1.10, 95% CI: 0.86, 1.42), while those with negative lymph nodes may have benefited from increasing numbers removed (HR 0.95, 95% CI: 0.89,1.02).
• The results of this study indicate a possible therapeutic benefit of lymph node removal in node negative patients. Future research should focus on gaining a better understanding of the biologic mechanisms of a possible therapeutic benefit of PLND, particularly for those lower risk patients with histologically negative lymph nodes.
• 研究盆腔淋巴结清扫术切除的淋巴结数量与前列腺癌死亡风险之间的关联，特别是在低至中危前列腺癌患者中。
• 利用一项基于人群的病例对照研究的亚组数据评估淋巴结清除对前列腺癌特异性死亡率的影响。• 本报告中包含的亚组为来自母体研究的 281 名接受前列腺切除术且行盆腔淋巴结清扫术的患者，以及我们记录了淋巴结切除数量的 41 名符合相同标准且在 10 年内死于前列腺癌的患者（病例）。• 研究变量包括切除的淋巴结数量、淋巴结状态、年龄、治疗前 PSA、T 分期、Gleason 评分和激素治疗的使用。• 我们进行了 Cox 比例风险回归分析，该分析考虑了研究设计，并使我们能够将这些患者和疾病特征视为所关注关联的潜在混杂因素。• 在二次分析中，根据淋巴结状态对结果进行分层。
• 粗死亡率比（HR），即相对风险的衡量标准，与 PLND 切除的淋巴结数量增加时前列腺癌死亡风险降低无关（HR：0.97，95%CI：0.91-1.03）。• 作为潜在混杂因素考虑的变量均未对粗 HR 产生影响。使用两个截断值对切除的淋巴结数量进行分类，一个在 4 个或更多，另一个在 10 个或更多，结果表明在两种情况下风险降低了 25%，尽管这些结果无统计学意义。• 当我们按病理淋巴结状态分析关联时，我们观察到阳性淋巴结组的风险可能增加（HR：1.10，95%CI：0.86，1.42），而阴性淋巴结组可能受益于切除数量的增加（HR 0.95，95%CI：0.89，1.02）。
• 本研究结果表明淋巴结阴性患者淋巴结清除可能具有治疗益处。未来的研究应重点深入了解 PLND 治疗益处的生物学机制，特别是对于那些具有组织学阴性淋巴结的低危患者。
