Gervasi L A, Mata J, Easley J D, Wilbanks J H, Seale-Hawkins C, Carlton C E, Scardino P T
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
J Urol. 1989 Aug;142(2 Pt 1):332-6. doi: 10.1016/s0022-5347(17)38748-7.
Pelvic lymph node metastases indicate a poor prognosis for patients with clinically localized prostate cancer but the significance of minimal nodal metastases still is debated. We determined the progression and cancer specific survival rates based on the extent of nodal metastases in 511 patients followed for a mean of 8.6 years (range 2.5 to 17.5 years) after bilateral pelvic lymph node dissection and irradiation therapy. The patients were divided into 4 groups based on the extent of nodal metastases: NO--negative nodes (359 patients), N1--a single microscopic positive node (37), N2--multiple microscopic positive nodes (86) and N3--grossly positive or juxtaregional nodes (29). The risks of distant metastases and of dying of prostate cancer were much greater in the 152 patients with positive nodes (N+) than in those with negative nodes (p less than 0.00005). The risk of metastatic disease at 10 years was only 31 +/- 7 per cent for the NO patients compared to 83 +/- 7 per cent for the N+ patients, and the risk of dying of prostate cancer was only 17 +/- 6 per cent at 10 years for the NO group and 57 +/- 11 per cent for the N+ patients. Patients with a single microscopic node (N1) had a pattern of progression and cancer specific mortality rate similar to patients with more extensive nodal metastases and markedly worse than patients with negative nodes. The risk of distant metastases was 80 +/- 15 per cent at 10 years for the N1 group, 84 +/- 11 per cent for the N2 group and 88 +/- 13 per cent for the N3 group, while the risk of dying of prostate cancer at 10 years was 40 +/- 19, 66 +/- 15 and 58 +/- 24 per cent, respectively. The finding of a single pelvic lymph node containing microscopic metastatic disease markedly worsened the prognosis of our patients with prostate cancer. Once prostate cancer is found within the pelvic lymph nodes the patient has systemic disease unlikely to be controlled by pelvic lymph node dissection and radiotherapy.
盆腔淋巴结转移提示临床局限性前列腺癌患者预后不良，但微小淋巴结转移的意义仍存在争议。我们在511例患者中，根据淋巴结转移程度确定了疾病进展情况和癌症特异性生存率，这些患者在接受双侧盆腔淋巴结清扫和放射治疗后平均随访8.6年（范围2.5至17.5年）。根据淋巴结转移程度将患者分为4组：NO组——淋巴结阴性（359例患者），N1组——单个显微镜下阳性淋巴结（37例），N2组——多个显微镜下阳性淋巴结（86例），N3组——肉眼可见阳性或近区域淋巴结（29例）。152例淋巴结阳性（N+）患者发生远处转移和死于前列腺癌的风险远高于淋巴结阴性患者（p<0.00005）。NO组患者10年时发生转移性疾病的风险仅为31±7%，而N+组患者为83±7%；NO组患者10年时死于前列腺癌的风险仅为17±6%，N+组患者为57±11%。单个显微镜下阳性淋巴结（N1）患者的疾病进展模式和癌症特异性死亡率与淋巴结转移更广泛的患者相似，且明显差于淋巴结阴性患者。N1组10年时远处转移风险为80±15%，N2组为84±11%，N3组为88±13%；而10年时死于前列腺癌的风险分别为40±19%、66±15%和58±24%。发现单个盆腔淋巴结存在显微镜下转移性疾病显著恶化了我们前列腺癌患者的预后。一旦在盆腔淋巴结中发现前列腺癌，患者即患有全身性疾病，不太可能通过盆腔淋巴结清扫和放疗得到控制。
