Winter Alexander, Kneib Thomas, Henke Rolf-Peter, Wawroschek Friedhelm
Department of Urology and Pediatric Urology, Clinical Center Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany.
Int J Urol. 2014 Jan;21(1):58-63. doi: 10.1111/iju.12184. Epub 2013 May 9.
To stratify the rate and prediction of lymph node involvement in prostate cancer patients undergoing sentinel-lymphadenectomy depending on preoperative tumor characteristics, and to compare the outcome with the European Association of Urology Guideline indication for lymphadenectomy.
A total of 1229 patients (median age 66 years) were treated with open sentinel-lymphadenectomy and prostatectomy between 2005 and 2009. Median preoperative prostate-specific antigen was 7.4 ng/mL. The rate of lymph node involvement was analyzed for D'Amico risk groups. Multivariable logistic regression was used to estimate the probability of lymph node involvement. Predictor variables included preoperative prostate-specific antigen, clinical T-category and biopsy Gleason sum. Predictive accuracy has been quantified (area under the curve) and lymph node positive patients were verified under consideration of the recommended European threshold for lymphadenectomy (nomogram-predicted lymph node invasion risk of >7%).
The median number of lymph nodes removed was 10 (interquartile range 7-13). Overall, 17.1% of patients had lymph node involvement; 3.2% in low-, 14.8% in intermediate- and 37.4% in high-risk disease. The predicted risk for lymph node involvement ranged from 2% (prostate-specific antigen ≤4 ng/mL, T1, Gleason sum ≤6) to 87% (prostate-specific antigen >20 ng/mL, T3, Gleason sum ≥8). The predictive accuracy was 82.1%. According to the European guidelines, 15.9% of all lymph node involved cases would not have been detected.
The rate of lymph node involvement seems to be higher in the examined sentinel collective than expected according to the European Guideline nomogram. The first sentinel-based lymph node involvement prediction model can assist in deciding on the indication for sentinel-lymphadenectomy. The validation of a corresponding sentinel-based nomogram is still missing.
根据术前肿瘤特征，对接受前哨淋巴结清扫术的前列腺癌患者的淋巴结转移率及预测情况进行分层，并将结果与欧洲泌尿外科协会淋巴结清扫术指南指征进行比较。
2005年至2009年间，共有1229例患者（中位年龄66岁）接受了开放性前哨淋巴结清扫术和前列腺切除术。术前前列腺特异性抗原中位数为7.4 ng/mL。分析了达米科风险组的淋巴结转移率。采用多变量逻辑回归估计淋巴结转移的概率。预测变量包括术前前列腺特异性抗原、临床T分期和活检Gleason评分总和。对预测准确性进行了量化（曲线下面积），并在考虑欧洲推荐的淋巴结清扫阈值（列线图预测淋巴结侵犯风险>7%）的情况下对淋巴结阳性患者进行了验证。
切除的淋巴结中位数为10个（四分位间距7 - 13）。总体而言，17.1%的患者有淋巴结转移；低风险疾病患者中为3.2%，中风险疾病患者中为14.8%，高风险疾病患者中为37.4%。淋巴结转移的预测风险范围为2%（前列腺特异性抗原≤4 ng/mL，T1，Gleason评分总和≤6）至87%（前列腺特异性抗原>20 ng/mL，T3，Gleason评分总和≥8）。预测准确性为8
