Tsurusaki Toshifumi, Yamasaki Yasuto, Maruta Sugure
Department of Urology, The Japanese Red Cross Nagasaki Genbaku Hospital.
Nihon Hinyokika Gakkai Zasshi. 2013 May;104(3):496-504. doi: 10.5980/jpnjurol.104.496.
We assessed the outcome after radical prostatectomy and extended pelvic lymphadenectomy in patients with untreated high-risk clinically localized prostate cancer, retrospectively.
Between 2001 and 2010, 89 patients for untreated high-risk clinically localized prostate cancer on the risk classification as defined by D'Amico, underwent retropubic radical prostatectomy and extended pelvic lymphadenectomy. Boundaries of the pelvic lymph node dissection field divided into external iliac vessels, obturator fossa, and internal iliac vessels. We investigated mainly the postoperative outcome of 84 patients without any adjuvant therapies. PSA recurrence-free survival among the pretreatment variables was estimated using Kaplan-Meier plots, and the statistical significance was determined by log rank test.
In 89 high-risk patients, 32.7% had pT3-pT4 tumors, 16.9% positive surgical margin, 6.7% positive lymph node metastases and 30.3% Gleason score 8-10 at the pathological examination. A median of 13 nodes (mean 14.0, range 9-25 nodes) were removed per patient. In 96.6% cases, postoperative PSA values decreased less than 0.2 ng/ml. The median observation period after operation was 1,819 days. Median PSA recurrence-free survival rates, overall survival and cancer cause-specific survival rates at 5 year, in 84 high-risk patients without any adjuvant therapies, were 73.8%, 100% and 100%, respectively. Median PSA recurrence-free survival rates according to pathological T stage and surgical margin status were statistically significant, but that according to preoperative 3 factors (clinical T stage, Gleason score at biopsy, preoperative PSA values) were statistically insignificant. Moreover, that according to both the number of positive preoperative 3 factors (1 vs. 2 positive factors) and the number of removed lymph nodes (< or =13 vs. > or = 14), were statistically insignificant. The median PSA recurrence-free survival rates at 5 year for positive margin cases were 0%.
Radical prostatectomy and extended pelvic lymphadenectomy is feasible in patients with high-risk clinically localized prostate cancer. We suggest that both wide resection and extended pelvic lymphadenectomy may improve the postoperative outcome for high-risk clinically localized prostate cancer.
我们回顾性评估了未经治疗的高危临床局限性前列腺癌患者行根治性前列腺切除术和扩大盆腔淋巴结清扫术后的结果。
2001年至2010年间，89例根据达米科定义的风险分类为未经治疗的高危临床局限性前列腺癌患者接受了耻骨后根治性前列腺切除术和扩大盆腔淋巴结清扫术。盆腔淋巴结清扫区域的边界分为髂外血管、闭孔窝和髂内血管。我们主要研究了84例未接受任何辅助治疗患者的术后结果。使用Kaplan-Meier曲线估计术前变量中的无PSA复发生存率，并通过对数秩检验确定统计学意义。
在89例高危患者中，病理检查显示32.7%有pT3-pT4肿瘤，16.9%手术切缘阳性，6.7%淋巴结转移阳性，30.3% Gleason评分8-10。每位患者平均切除13个淋巴结（平均14.0个，范围9-25个）。96.6%的病例术后PSA值下降至低于0.2 ng/ml。术后中位观察期为1819天。84例未接受任何辅助治疗的高危患者5年时的中位无PSA复发生存率、总生存率和癌症特异性生存率分别为73.8%、100%和100%。根据病理T分期和手术切缘状态的中位无PSA复发生存率具有统计学意义，但根据术前3个因素（临床T分期、活检时的Gleason评分、术前PSA值）的无PSA复发生存率无统计学意义。此外，根据术前3个阳性因素的数量（1个与2个阳性因素）和切除淋巴结的数量（<或=13个与>或=14个）的无PSA复发生存率也无统计学意义。手术切缘阳性病例5年时的中位无PSA复发生存率为0%。
根治性前列腺切除术和扩大盆腔淋巴结清扫术对于高危临床局限性前列腺癌患者是可行的。我们认为广泛切除和扩大盆腔淋巴结清扫术可能会改善高危临床局限性前列腺癌患者的术后结果。
