Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2015 Jan;193(1):111-6. doi: 10.1016/j.juro.2014.08.082. Epub 2014 Aug 20.
We report salvage lymph node dissections for prostate cancer nodal recurrence detected by (11)C-choline positron emission tomography/computerized tomography in the setting of increasing prostate specific antigen after radical prostatectomy.
Retrospective chart review was performed for all patients who underwent salvage lymph node dissection for prostate cancer nodal recurrence. Only patients previously treated with radical prostatectomy were included in the study and those with evidence of local recurrence were excluded from analysis. Primary end points included biochemical recurrence, systemic progression and cancer specific mortality.
From 2009 to 2013, 52 men underwent salvage lymph node dissection. Before salvage lymph node dissection 78.8% (41 of 52) had some form of therapy after radical prostatectomy. Median age at salvage lymph node dissection was 60 years and median prostate specific antigen was 2.2 ng/ml (IQR 1.4-3.7). The median number of lymph nodes dissected was 21.5 (IQR 16-30) and the median number of positive nodes was 3.5 (IQR 1.2-6.5). Since salvage lymph node dissection 46.2% of the men (24 of 52) have had no further treatment, 34.6% (18 of 52) are on hormonal therapy and 19.2% (10 of 52) have received multiple different treatments. At the last followup at a median of 20 months (IQR 8-33), 57.7% (30 of 52) had prostate specific antigen remain less than 0.2 ng/ml, 75% (39 of 52) remained free of systemic progression and 96.2% of the men (50 of 52) were alive. Two patients died of prostate cancer. Three-year biochemical recurrence-free, systemic progression-free and cancer specific survival was 45.5%, 46.9% and 92.5%, respectively.
This represents the largest U.S. series of salvage lymph node dissection in the setting of lymph node metastatic prostate cancer after radical prostatectomy. Although followup was short and the study lacked a randomized control group, salvage lymph node dissection may represent a valid treatment option.
我们报告了在根治性前列腺切除术后前列腺特异性抗原（PSA）持续升高的情况下，通过（11）C-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）检测到前列腺癌淋巴结复发后进行挽救性淋巴结清扫的结果。
对所有接受挽救性淋巴结清扫治疗前列腺癌淋巴结复发的患者进行了回顾性病历分析。仅纳入既往接受根治性前列腺切除术治疗且无局部复发证据的患者进行研究。主要终点包括生化复发、系统进展和癌症特异性死亡率。
2009 年至 2013 年，52 例患者接受了挽救性淋巴结清扫。在接受挽救性淋巴结清扫之前，78.8%（41/52）在根治性前列腺切除术后接受了某种形式的治疗。挽救性淋巴结清扫时的中位年龄为 60 岁，中位 PSA 为 2.2ng/ml（IQR 1.4-3.7）。中位淋巴结清扫数为 21.5（IQR 16-30），阳性淋巴结数为 3.5（IQR 1.2-6.5）。自挽救性淋巴结清扫以来，46.2%（24/52）的患者未再接受任何治疗，34.6%（18/52）接受了激素治疗，19.2%（10/52）接受了多种不同的治疗。在中位随访时间 20 个月（IQR 8-33）时，57.7%（30/52）的患者 PSA 仍低于 0.2ng/ml，75%（39/52）未发生系统进展，96.2%（50/52）的患者存活。2 例患者死于前列腺癌。3 年生化无复发生存率、系统无进展生存率和癌症特异性生存率分别为 45.5%、46.9%和 92.5%。
这是美国最大的一组根治性前列腺切除术后前列腺癌淋巴结转移后行挽救性淋巴结清扫的患者系列研究。尽管随访时间较短且研究缺乏随机对照分组，但挽救性淋巴结清扫可能是一种有效的治疗选择。
