Kazzazi Amir, Djavan Bob
Department of Urology, New York University School of Medicine, NYU, New York, USA.
Can J Urol. 2011 Apr;18(2):5585-91.
Controversy persists concerning the role of pelvic lymph node dissection (PLND) in patients with clinically localized prostate cancer undergoing radical prostatectomy. The aim of this review is to critically evaluate the current status on PLND in prostate cancer.
A review of the literature was performed concerning radical prostatectomy and PLND with respect to oncological outcome, associated complications, nodal yield, indications and minimal number of nodes required.
PLND is still the modality of choice for detecting lymph node metastasis in prostate cancer. Current imaging techniques are not accurate enough for detecting nodal metastases. Extended PLND has complications that increase with extent of dissection. Nodal yield at PLND is directly related to the lymph node invasion (LNI) rate and greater nodal yield is associated with superior staging accuracy. Based on MSKCC nomogram and in conjunction with prospective confirmation studies a novel nomogram (the New York nomogram) was designed.
Removing at least 10 lymph nodes is recommended to detect LNI. For patients with high and intermediate risk disease, extended PLND at least for external iliac, obturator and hypogastric lymph nodes should be performed during radical prostatectomy. However, for patients with low risk disease, PLND is not necessary and is not recommended, because the chance of metastasis is low.
对于接受根治性前列腺切除术的临床局限性前列腺癌患者，盆腔淋巴结清扫术（PLND）的作用仍存在争议。本综述的目的是批判性地评估前列腺癌中PLND的现状。
对有关根治性前列腺切除术和PLND的文献进行了综述，内容涉及肿瘤学结局、相关并发症、淋巴结检出率、适应症以及所需的最少淋巴结数量。
PLND仍然是检测前列腺癌淋巴结转移的首选方式。目前的成像技术在检测淋巴结转移方面不够准确。扩大性PLND的并发症会随着清扫范围的扩大而增加。PLND的淋巴结检出率与淋巴结侵犯（LNI）率直接相关，更高的淋巴结检出率与更高的分期准确性相关。基于纪念斯隆凯特琳癌症中心（MSKCC）列线图并结合前瞻性验证研究，设计了一种新的列线图（纽约列线图）。
建议切除至少10个淋巴结以检测LNI。对于高风险和中风险疾病患者，在根治性前列腺切除术期间应至少对髂外、闭孔和下腹淋巴结进行扩大性PLND。然而，对于低风险疾病患者，PLND没有必要且不建议进行，因为转移的可能性较低。
