Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany.
J Urol. 2012 Dec;188(6):2190-7. doi: 10.1016/j.juro.2012.08.041. Epub 2012 Oct 18.
We evaluated the impact of salvage lymph node dissection with adjuvant radiotherapy in patients with nodal recurrence of prostate cancer. By default, nodal recurrence of prostate cancer is treated with palliative antihormonal therapy, which causes serious side effects and invariably leads to the development of hormone refractory disease.
A total of 47 patients with nodal recurrence of prostate cancer based on evidence of (11)C-choline/(18)F-choline ((18)F-fluorethylcholine) positron emission tomography-computerized tomography underwent primary (2 of 52), secondary (45 of 52), tertiary (4 of 52) and quaternary (1 of 52) salvage lymph node dissection with histological confirmation. Of 52 salvage lymph node dissections 27 were followed by radiotherapy. Biochemical response was defined as a prostate specific antigen less than 0.2 ng/ml after salvage therapy. The Kaplan-Meier method, binary logistic regression and Cox regression were used to analyze survival as well as predictors of biochemical response and clinical progression.
Mean prostate specific antigen at salvage lymph node dissection was 11.1 ng/ml. A mean of 23.3 lymph nodes were removed per salvage lymph node dissection. Median followup was 35.5 months. Of 52 salvage lymph node dissections 24 resulted in complete biochemical response followed by 1-year biochemical recurrence-free survival of 71.8%. Gleason 6 or less (OR 7.58, p = 0.026), Gleason 7a/b (OR 5.91, p = 0.042) and N0 status at primary therapy (OR 8.01, p = 0.011) were identified as independent predictors of biochemical response. Gleason 8-10 (HR 3.5, p = 0.039) as a preoperative variable, retroperitoneal positive lymph nodes (HR 3.76, p = 0.021) and incomplete biochemical response (HR 4.0, p = 0.031) were identified as postoperative predictors of clinical progression. Clinical progression-free survival was 25.6% and cancer specific survival was 77.7% at 5 years.
Based on (11)C/(18)F-choline positron emission tomography-computerized tomography as a diagnostic tool, salvage lymph node dissection is feasible for the treatment of nodal recurrence of prostate cancer. Most patients experience biochemical recurrence after salvage lymph node dissection. However, a specific population has a lasting complete prostate specific antigen response.
我们评估了挽救性淋巴结清扫术联合辅助放疗在前列腺癌淋巴结复发患者中的作用。默认情况下，前列腺癌淋巴结复发采用姑息性抗激素治疗，这会导致严重的副作用，并且不可避免地导致激素难治性疾病的发展。
共 47 例基于（11）C-胆碱/（18）F-胆碱（（18）F-氟乙基胆碱）正电子发射断层扫描-计算机断层扫描证据的前列腺癌淋巴结复发患者（11）C-胆碱/（18）F-胆碱（（18）F-氟乙基胆碱）正电子发射断层扫描-计算机断层扫描进行了初次（2/52）、二次（45/52）、三次（4/52）和四次（1/52）挽救性淋巴结清扫术，均有组织学证实。52 例挽救性淋巴结清扫术中有 27 例接受了放疗。生化缓解定义为挽救治疗后前列腺特异性抗原（PSA）<0.2ng/ml。采用 Kaplan-Meier 法、二项逻辑回归和 Cox 回归分析生存情况及生化缓解和临床进展的预测因素。
挽救性淋巴结清扫术时 PSA 的平均水平为 11.1ng/ml。平均每例挽救性淋巴结清扫术切除 23.3 个淋巴结。中位随访时间为 35.5 个月。52 例挽救性淋巴结清扫术中有 24 例完全生化缓解，1 年生化无复发生存率为 71.8%。Gleason 评分 6 或更低（OR 7.58，p=0.026）、Gleason 评分 7a/b（OR 5.91，p=0.042）和初次治疗时 N0 状态（OR 8.01，p=0.011）被确定为生化缓解的独立预测因素。术前 Gleason 评分 8-10（HR 3.5，p=0.039）、腹膜后阳性淋巴结（HR 3.76，p=0.021）和不完全生化缓解（HR 4.0，p=0.031）被确定为术后临床进展的预测因素。5 年时无临床进展生存率为 25.6%，癌症特异性生存率为 77.7%。
基于（11）C/（18）F-胆碱正电子发射断层扫描-计算机断层扫描作为诊断工具，挽救性淋巴结清扫术可用于治疗前列腺癌淋巴结复发。大多数患者在挽救性淋巴结清扫术后经历生化复发。然而，有一个特定的人群具有持久的完全前列腺特异性抗原反应。
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