根治性前列腺切除术中对于低危前列腺癌是否需要进行盆腔淋巴结清扫？

Is pelvic lymph node dissection required at radical prostatectomy for low-risk prostate cancer?

机构信息

Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan; Michinoku Japan Urological Cancer Study Group, Japan.

出版信息

Int J Urol. 2013 Nov;20(11):1092-6. doi: 10.1111/iju.12112. Epub 2013 Feb 6.

DOI:10.1111/iju.12112

PMID:23387553

Abstract

OBJECTIVES

To determine the necessity of pelvic lymph node dissection for low-risk prostate cancer, we analyzed the incidence of lymph node invasion and the therapeutic value of pelvic lymph node dissection in low-risk prostate cancer patients.

METHODS

Medical records for 1268 patients undergoing open radical prostatectomy between January 2000 and December 2009 who had not undergone neoadjuvant therapy were retrospectively reviewed. Patients with low-risk disease (n = 222; prostate-specific antigen <10 ng/mL, biopsy Gleason score ≤6, clinical T1c or T2a) were classified according to whether they underwent pelvic lymph node dissection (pelvic lymph node dissection group, n = 147) or did not (no pelvic lymph node dissection group, n = 75). Pelvic lymph node dissection was carried out in a limited style, which included the external iliac vein and the obturator fossa. The incidence of lymph node invasion was determined and referred to the preoperative nomogram developed for Japanese patients (Japanese nomogram), Partin and Kattan nomograms. The 5-year biochemical recurrence-free survivals in both groups were analyzed.

RESULTS

Lymph node invasion in low-, intermediate- and high-risk disease was 0.7% (1/147), 1.2% (7/595) and 6.1% (23/374). The 5-year biochemical recurrence-free survival rates for patients with low-risk disease were 87.6% in the pelvic lymph node dissection group and 87.1% in the no pelvic lymph node dissection group (P = 0.65, log-rank). No patients in the pelvic lymph node dissection group exceeded 2% of lymph node invasion risk with Japanese and Partin nomograms. With the Kattan nomogram, 22.4% (33/147) of the pelvic lymph node dissection group exceeded 2% of lymph node invasion risk, and one patient had documented lymph node invasion, but none exceeded 2.5%.

CONCLUSIONS

Pelvic lymph node dissection can be spared at radical prostatectomy for low-risk disease, as its diagnostic and therapeutic value is poor.

摘要

目的

为了确定对低危前列腺癌行盆腔淋巴结清扫术的必要性，我们分析了低危前列腺癌患者中淋巴结侵犯的发生率和盆腔淋巴结清扫术的治疗价值。

方法

回顾性分析了 2000 年 1 月至 2009 年 12 月期间行开放性根治性前列腺切除术且未接受新辅助治疗的 1268 例患者的病历资料。根据是否行盆腔淋巴结清扫术（行盆腔淋巴结清扫术组，n=147；前列腺特异性抗原＜10ng/ml，活检 Gleason 评分≤6，临床 T1c 或 T2a），将低危疾病患者（n=222；前列腺特异性抗原＜10ng/ml，活检 Gleason 评分≤6，临床 T1c 或 T2a）分为行盆腔淋巴结清扫术（行盆腔淋巴结清扫术组，n=147）和未行盆腔淋巴结清扫术（未行盆腔淋巴结清扫术组，n=75）。行盆腔淋巴结清扫术时采用了局限性方式，包括髂外静脉和闭孔窝。根据术前为日本患者开发的列线图（日本列线图）、Partin 和 Kattan 列线图确定淋巴结侵犯的发生率，并参考这些列线图。分析两组患者的 5 年生化无复发生存率。

结果

低危、中危和高危疾病的淋巴结侵犯率分别为 0.7%（1/147）、1.2%（7/595）和 6.1%（23/374）。行盆腔淋巴结清扫术组低危疾病患者的 5 年生化无复发生存率为 87.6%，未行盆腔淋巴结清扫术组为 87.1%（P=0.65，对数秩检验）。日本列线图和 Partin 列线图显示，行盆腔淋巴结清扫术组中无一例患者的淋巴结侵犯风险超过 2%。Kattan 列线图显示，行盆腔淋巴结清扫术组中有 22.4%（33/147）的患者的淋巴结侵犯风险超过 2%，1 例患者存在淋巴结侵犯的记录，但均未超过 2.5%。