Departments of Urology and Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
BJU Int. 2011 Oct;108(8):1262-8. doi: 10.1111/j.1464-410X.2010.10016.x. Epub 2011 Mar 29.
• To assess the impact of pelvic lymph node dissection (PLND) and of the number of lymph nodes (LNs) retrieved during radical prostatectomy (RP) on biochemical relapse (BCR) in pNX/0/1 patients with prostate cancer according to the clinical risk of lymph node invasion (LNI).
• We evaluated 872 pT2-4 NX/0/1 consecutive patients submitted to RP between October 1995 and June 2009, with the following inclusion criteria: (i) a follow-up period ≥12 months; (ii) the avoidance of neoadjuvant hormonal therapy or adjuvant hormonal and/or adjuvant radiotherapy; (iii) the availability of complete follow-up data; (iv) no pathological T0 disease; (v) complete data regarding the clinical stage and Gleason score (Gs), the preoperative prostate-specific antigen (PSA) level and the pathological stage. • The patients were stratified as having low risk (cT1a-T2a and cGs ≤6 and PSA level < 10 ng/mL), intermediate risk (cT2b-T2c or cGs = 7 or PSA level = 10-19.9) or high risk of LNI (cT3 or cGs = 8-10 or PSA level ≥ 20). • The 872 patients were divided into two LN groups according to the number of LNs retrieved: group 1 had no LN or one to nine LNs removed; group 2 had 10 or more LNs. • The variables analysed were LN group, age, PSA level, clinical and pathological stage and Gs, surgical margin status, LN status and number of LN metastases; the primary endpoint was the BCR-free survival.
• The mean follow-up was 55.8 months. • Of all the patients, 305 (35%) were pNx and 567 (65.0%) were pN0/1. • Of the 567 patients submitted to PLND, the mean number of LNs obtained was 10.9, and 49 (8.6%) were pN1. • In the 402 patients at low risk of LNI, LN group was not a significant predictor of BCR at univariate analysis, while in the 470 patients at intermediate and high risk of LNI, patients with ≥ 10 LNs removed had a significantly lower BCR-free survival at univariate and multivariate analysis.
• In our study population, a more extensive PLND positively affects the BCR-free survival regardless of the nodal status in intermediate- and high-risk prostate cancer.
根据临床淋巴结侵犯风险（LNI）评估前列腺癌患者 pNX/0/1 期行根治性前列腺切除术（RP）时行盆腔淋巴结清扫术（PLND）和淋巴结（LN）检出数量对生化复发（BCR）的影响。
我们评估了 872 例连续接受 RP 的 pT2-4 NX/0/1 例患者，纳入标准如下：（i）随访时间≥12 个月；（ii）避免新辅助激素治疗或辅助激素和/或辅助放疗；（iii）具备完整随访数据；（iv）无病理学 T0 疾病；（v）完整的临床分期和 Gleason 评分（Gs）、术前前列腺特异性抗原（PSA）水平和病理学分期数据。（v）患者分为低危（cT1a-T2a 和 cGs≤6 和 PSA 水平<10ng/mL）、中危（cT2b-T2c 或 cGs=7 或 PSA 水平=10-19.9）或高危（cT3 或 cGs=8-10 或 PSA 水平≥20ng/mL）LNI 风险。（iv）872 例患者根据检出的 LN 数量分为两组：LN 组 1 无 LN 或检出 1-9 个 LN；LN 组 2 检出 10 个或更多 LN。
分析的变量包括 LN 组、年龄、PSA 水平、临床和病理分期和 Gs、手术切缘状态、LN 状态和 LN 转移数；主要终点为 BCR 无复发生存率。
所有患者中，305 例（35%）为 pNx，567 例（65.0%）为 pN0/1。567 例行 PLND 的患者中，平均检出 LN 数为 10.9 个，49 例（8.6%）为 pN1。在低 LNI 风险的 402 例患者中，LN 组在单因素分析中不是 BCR 的显著预测因素，而在中高危 LNI 的 470 例患者中，多因素分析显示，检出≥10 个 LN 的患者 BCR 无复发生存率显著降低。
在我们的研究人群中，更广泛的 PLND 可降低生化复发率，无论中间和高危前列腺癌的淋巴结状态如何。
