Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
BJU Int. 2013 Jul;112(2):216-23. doi: 10.1111/j.1464-410X.2012.11765.x. Epub 2013 Jan 29.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Although lymph node dissection (LND) is known as the most accurate method of nodal staging, the therapeutic role of LND remains undetermined. This is mainly because of the lack of randomized prospective studies and the fact that retrospective analyses often result in bias and misinterpretation. To overcome the limitation of retrospective analysis, we matched preoperative variables using propensity scores and compared the outcomes between patients treated with robot-assisted eLND and sLND. In the matched cohort, robot-asssited eLND achieved an increased detection rate of lymph node metastases; however, the therapeutic benefit was not statistically significant between the two groups on short-term follow-up.
To compare the pathological and biochemical outcomes between extended lymph node dissection (eLND) and standard lymph node dissection (sLND) in patients undergoing robot-assisted radical prostatectomy for intermediate- or high-risk prostate cancer.
A total of 905 patients underwent robot-assisted radical prostatectomy and lymph node dissection (LND) by a single surgeon between June 2006 and January 2011. Of these, 170 patients who underwent robot-assisted eLND and 294 patients who underwent robot-assisted sLND for intermediate- or high-risk prostate cancer were included in the study. Propensity-score matching was performed using the preoperative variables which included age, body mass index, prostate-specific antigen, clinical stage, biopsy Gleason score 1 and 2, total number of biopsied cores, number of positive cores and prostate volumes. Pathological and biochemical outcomes were assessed according to the extent of LND.
The median (range) follow-up period was 36 (12-77) months and the median number of lymph nodes removed was 21 and 12 in the eLND and sLND groups, respectively. Propensity-score matching resulted in 141 patients in each group. Although patients who underwent eLND had a higher clinical stage, biopsy Gleason score and number of positive cores than those treated with sLND in the entire cohort, there were no preoperative between-group differences in the matched cohort. In the matched cohort, lymph node metastases were detected at a significantly higher rate in the eLND than in the sLND group (12.1 vs. 5.0%, P = 0.033). In the matched cohort, the 3-year biochemical recurrence-free survival rates were 77.8 and 73.5% in the eLND and sLND groups, respectively, which was not significant (hazard ratio 0.85, P = 0.497).
Robot-assisted eLND achieved an increased lymph node yield and higher detection rate of lymph node metastases; however, robotic eLND did not alter biochemical outcomes in a short-term follow-up.
比较机器人辅助根治性前列腺切除术治疗中高危前列腺癌患者行扩大淋巴结清扫术（eLND）与标准淋巴结清扫术（sLND）的病理和生化结果。
回顾性分析 2006 年 6 月至 2011 年 1 月期间由同一位外科医生施行机器人辅助根治性前列腺切除术和淋巴结清扫术（LND）的 905 例患者的资料。其中 170 例行机器人辅助 eLND，294 例行机器人辅助 sLND，所有患者均为中高危前列腺癌。采用倾向评分匹配术前变量，包括年龄、体重指数、前列腺特异性抗原、临床分期、活检 Gleason 评分 1 和 2、活检核心总数、阳性核心数和前列腺体积。根据 LND 范围评估病理和生化结果。
中位（范围）随访时间为 36（12-77）个月，eLND 和 sLND 组的中位淋巴结清扫数分别为 21 和 12 枚。倾向评分匹配后，每组各有 141 例患者。虽然 eLND 组患者的临床分期、活检 Gleason 评分和阳性核心数均高于 sLND 组，但在整个队列中，两组患者术前无差异。在匹配队列中，eLND 组的淋巴结转移率明显高于 sLND 组（12.1% vs. 5.0%，P = 0.033）。在匹配队列中，eLND 和 sLND 组的 3 年生化无复发生存率分别为 77.8%和 73.5%，差异无统计学意义（风险比 0.85，P = 0.497）。
机器人辅助 eLND 可增加淋巴结检出量，提高淋巴结转移的检出率；但短期内对生化结果无影响。
