The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Prostate. 2013 Nov;73(15):1673-80. doi: 10.1002/pros.22702. Epub 2013 Sep 9.
We report the 30-year institutional experience of radical prostatectomy (RP) for men with clinically localized prostate cancer (PC) found to have lymph node (LN) metastases at surgery.
The Johns Hopkins RP Database (1982-2011) was queried for 505 (2.5%) men with node-positive (N1) PC. Survival analysis was completed using the Kaplan-Meier method and proportional hazard regression models.
The proportion of men with N1PC was 8.3%, 3.5%, and 1.4% in the pre- (1982-1990), early- (1991-2000), and contemporary-PSA eras (2001-2011), respectively. A trend toward decreasing PSA, less palpable disease but more advanced Gleason sum was noted in the most contemporary era. Median total and positive nodes were 13.2 (1-41) and 1.7 (1-12), respectively. Of 135 patients with a unilateral tumor, 80 (59.3%), 28 (20.7%), and 15 (11.1%) had ipsilateral, contralateral, and bilateral positive LN. 15-year biochemical-recurrence free, metastases-free and cancer-specific survival was 7.1%, 41.5%, and 57.5%, respectively. Predictors of biochemical-recurrence, metastases and death from PC in multivariate analysis included Gleason sum at RP, the number and percent of positive LN; notably total number of LN dissected did not predict outcome.
In this highly-selected RP cohort, men found to have N1PC disease at RP can experience a durable long-term metastases-free and cancer-specific survival. Predictors of survival include Gleason sum, number, and percentage of positive LN. While total number of LN dissected was not predictive, approximately 30% of men with N1PC will have positive LN contralateral to the primary prostatic lesion highlighting the importance of a thorough, bilateral pelvic LN dissection.
我们报告了 30 年来对手术时发现淋巴结（LN）转移的局限性前列腺癌（PC）患者进行根治性前列腺切除术（RP）的机构经验。
约翰霍普金斯 RP 数据库（1982-2011 年）查询了 505 名（2.5%）淋巴结阳性（N1）PC 患者的信息。采用 Kaplan-Meier 法和比例风险回归模型进行生存分析。
N1PC 患者在术前（1982-1990 年）、早期（1991-2000 年）和当代 PSA 时代（2001-2011 年）的比例分别为 8.3%、3.5%和 1.4%。在最近的时代，我们注意到 PSA 呈下降趋势，可触及的疾病减少，但 Gleason 总和更高级。中位总淋巴结和阳性淋巴结分别为 13.2（1-41）和 1.7（1-12）。在 135 名单侧肿瘤患者中，80 名（59.3%）、28 名（20.7%）和 15 名（11.1%）同侧、对侧和双侧 LN 阳性。15 年生化无复发生存率、无转移生存率和癌症特异性生存率分别为 7.1%、41.5%和 57.5%。多变量分析中，生化复发、转移和 PC 死亡的预测因素包括 RP 时的 Gleason 总和、阳性 LN 的数量和百分比；值得注意的是，LN 清扫总数与结局无关。
在这个高度选择的 RP 队列中，手术时发现 N1PC 疾病的患者可以获得持久的无转移和癌症特异性生存。生存的预测因素包括 Gleason 总和、阳性 LN 的数量和百分比。尽管 LN 清扫总数没有预测价值，但约 30%的 N1PC 患者的原发性前列腺病变对侧会出现阳性 LN，这突出了彻底的双侧骨盆 LN 清扫的重要性。
