Busch Jonas, Hinz Stefan, Kempkensteffen Carsten, Erber Barbara, Klopf Christian, Weikert Steffen, Miller Kurt, Magheli Ahmed
Department of Urology, Charité University Medicine Berlin, Berlin, Germany.
Urol Int. 2012;88(4):441-6. doi: 10.1159/000335206. Epub 2012 Mar 7.
No relevant data have been published on the impact of retroperitoneal lymph node dissection (LND) on clinical outcome in patients with castration-resistant prostate cancer.
We retrospectively studied the records of 6 patients with lymph node metastases from castration-resistant prostate cancer who underwent a retroperitoneal LND between 2005 and 2010. Complication rate and clinical outcome were examined.
Mean patient age was 69.2 (63-81) years. Primary therapy was radical prostatectomy, radiation therapy, or pelvic LND and androgen deprivation in 3, 2 and 1 cases, respectively. Mean prostate-specific antigen (PSA) at LND was 37.6 (20.3-139) ng/dl. LND was performed as a modified unilateral (n = 3), bilateral (n = 1) and bilateral extended (n = 2) approach with a median lymph node density of 0.739 (0.111-1). Preoperative Charlson index was 0 (n = 3) or 1 (n = 3). No intra- or postoperative complications occurred. The average postoperative decline of PSA was 39.3% (-99.4 to +31.3). Differences between mean pre- and postoperative PSA velocities and densities were 23.9 ng/ml/year and 11.2 months, respectively (p = 0.24 and p = 0.40). Four patients (67%) developed bone metastases after a mean period of 23.5 (5-58) months. Median bone metastases-free survival was 15.5 months and median overall survival after LND was 31.7 months on Kaplan-Meier analysis.
A selective LND in castration-resistant prostate cancer patients could be safely performed. A positive effect on the PSA and PSA kinetics was accomplished for the majority of patients. This new surgical approach represents an alternative treatment option in the palliative setting of prostate cancer patients and could delay toxic systemic therapy up to 12 months.
关于腹膜后淋巴结清扫术（LND）对去势抵抗性前列腺癌患者临床结局的影响，尚无相关数据发表。
我们回顾性研究了2005年至2010年间6例因去势抵抗性前列腺癌发生淋巴结转移而接受腹膜后LND的患者记录。检查了并发症发生率和临床结局。
患者平均年龄为69.2（63 - 81）岁。初始治疗分别为根治性前列腺切除术、放射治疗或盆腔LND及雄激素剥夺治疗，各有3例、2例和1例。LND时前列腺特异性抗原（PSA）平均为37.6（20.3 - 139）ng/dl。LND采用改良单侧（n = 3）、双侧（n = 1）和双侧扩大（n = 2）入路，中位淋巴结密度为0.739（0.111 - 1）。术前Charlson指数为0（n = 3）或1（n = 3）。未发生术中或术后并发症。术后PSA平均下降39.3%（-99.4至+31.3）。术前和术后PSA速度及密度的平均差异分别为23.9 ng/ml/年和11.2个月（p = 0.24和p = 0.40）。4例患者（67%）在平均23.5（5 - 58）个月后发生骨转移。根据Kaplan-Meier分析，中位无骨转移生存期为15.5个月，LND后的中位总生存期为31.7个月。
去势抵抗性前列腺癌患者可安全地进行选择性LND。大多数患者的PSA及PSA动力学得到了积极影响。这种新的手术方法是前列腺癌患者姑息治疗中的一种替代治疗选择，可将毒性全身治疗延迟长达12个月。
