Passoni Niccolo M, Fajkovic Harun, Xylinas Evanguelos, Kluth Luis, Seitz Christian, Robinson Brian D, Rouprêt Morgan, Chun Felix K, Lotan Yair, Roehrborn Claus G, Crivelli Joseph J, Karakiewicz Pierre I, Scherr Douglas S, Rink Michael, Graefen Markus, Schramek Paul, Briganti Alberto, Montorsi Francesco, Tewari Ashutosh, Shariat Shahrokh F
Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.
BJU Int. 2014 Oct;114(4):503-10. doi: 10.1111/bju.12342. Epub 2014 Apr 3.
To assess the prognostic role of extranodal extension (ENE) and the size of the largest lymph node (LN) metastasis in predicting early biochemical relapse (eBCR) in patients with LN metastasis after radical prostatectomy (RP).
We evaluated BCR-free survival in men with LN metastases after RP and pelvic LN dissection performed in six high-volume centres. Multivariable Cox regression tested the role of ENE and diameter of largest LN metastasis in predicting eBCR after adjusting for clinicopathological variables. We compared the discrimination of multivariable models including ENE, the size of largest LN metastasis and the number of positive LNs.
Overall, 484 patients were included. The median (interquartile range, IQR) follow-up was 16.1 (6-27.5) months. The median (IQR) number of removed LNs was 10 (4-14), and the median (IQR) number of positive LNs was 1 (1-2). ENE was present in 280 (58%) patients, and 211 (44%) had their largest metastasis >10 mm. Patients with ENE and/or largest metastasis of >10 mm had significantly worse eBCR-free survival (all P < 0.01). On multivariable analysis, number of positive LNs (≤2 vs >2) and the diameter of LN metastasis (≤10 vs >10 mm), but not ENE, were significant predictors of eBCR (all P < 0.003). ENE and diameter of LN metastasis increased the area under the curve of a baseline multivariable model (0.663) by 0.016 points.
The diameter of the largest LN metastasis and the number of positive LNs are independent predictors of eBCR. Considered together, ENE and the diameter of the largest LN metastasis have less discrimination than the number of positive LNs.
评估淋巴结外侵犯（ENE）及最大淋巴结转移灶大小在预测根治性前列腺切除术（RP）后发生淋巴结转移患者早期生化复发（eBCR）中的预后作用。
我们评估了在6个大型中心接受RP及盆腔淋巴结清扫术的有淋巴结转移男性患者的无生化复发生存期。多变量Cox回归分析在调整临床病理变量后，检验ENE及最大淋巴结转移灶直径在预测eBCR中的作用。我们比较了包含ENE、最大淋巴结转移灶大小及阳性淋巴结数量的多变量模型的判别能力。
共纳入484例患者。中位（四分位间距，IQR）随访时间为16.1（6 - 27.5）个月。切除淋巴结的中位（IQR）数量为10（4 - 14）个，阳性淋巴结的中位（IQR）数量为1（1 - 2）个。280例（58%）患者存在ENE，211例（44%）患者最大转移灶>10 mm。存在ENE和/或最大转移灶>10 mm的患者无eBCR生存期显著更差（均P < 0.01）。多变量分析显示，阳性淋巴结数量（≤2个与>2个）及淋巴结转移灶直径（≤10 mm与>10 mm）而非ENE是eBCR的显著预测因素（均P < 0.003）。ENE及淋巴结转移灶直径使基线多变量模型（0.663）的曲线下面积增加了0.016分。
最大淋巴结转移灶直径及阳性淋巴结数量是eBCR的独立预测因素。综合来看，ENE及最大淋巴结转移灶直径的判别能力低于阳性淋巴结数量。
