Qin Xiaojian, Han Chengtao, Zhang Hailiang, Dai Bo, Zhu Yao, Shen Yijun, Zhu Yiping, Shi Guohai, Ye Dingwei
Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
World J Surg Oncol. 2015 May 6;13:172. doi: 10.1186/s12957-015-0597-3.
The aim of this study is to assess the prognosis of prostate cancer (PCa) with lymph node metastases (LNM) detected in pelvic lymph node dissection (PLND) after radical prostatectomy (RP) and adjuvant androgen deprivation therapy (ADT) in a Chinese population.
From June 2005 to September 2012, the medical histories of 67 Chinese PCa patients with LNM detected after RP and extended PLND were collected, and all these patients received continuous adjuvant ADT. Postoperative survival was estimated using the Kaplan-Meier method. The impact of various clinicopathological factors on outcome was analyzed using Cox proportional hazard regression models. All tests were two-sided with P < 0.05 considered significant.
Median follow-up was 46.7 months, and two patients were lost to follow-up. Five-year event-free survival for patients with positive lymph nodes was 93.0%, 83.0%, and 96.0% for local recurrence, systemic progression, and cancer death, respectively. One-year, 2-year, and 3-year biochemical recurrence (BCR)-free survival was 52%, 40%, and 22%, respectively. Postoperative BCR-free survival was 25.7 months. BCR-free survival for patients with a single LNM was longer than those with two or more LNM (median 39.1 months vs. median 17.2 months, P = 0.002). In a multivariate Cox model, only two or more LNM was a significant predictor of BCR (hazard ratio 2.6, P = 0.005).
Despite low BCR-free survival, Chinese patients with LNM can benefit from RP and adjuvant ADT. Patients with low nodal metastatic burden had a favorable prognosis.
本研究旨在评估在中国人群中，根治性前列腺切除术（RP）及辅助雄激素剥夺治疗（ADT）后，盆腔淋巴结清扫术（PLND）检测到有淋巴结转移（LNM）的前列腺癌（PCa）患者的预后情况。
收集2005年6月至2012年9月期间67例RP及扩大PLND术后检测到LNM的中国PCa患者的病史，所有患者均接受持续辅助ADT治疗。采用Kaplan-Meier法估计术后生存率。使用Cox比例风险回归模型分析各种临床病理因素对预后的影响。所有检验均为双侧检验，P<0.05认为具有统计学意义。
中位随访时间为46.7个月，2例患者失访。淋巴结阳性患者的5年无事件生存率分别为：局部复发93.0%、全身进展83.0%、癌症死亡96.0%。1年、2年和3年无生化复发（BCR）生存率分别为52%、40%和22%。术后无BCR生存时间为25.7个月。单个LNM患者的无BCR生存期长于两个或更多LNM患者（中位39.1个月对中位17.2个月，P = 0.002）。在多变量Cox模型中，只有两个或更多LNM是BCR的显著预测因素（风险比2.6，P = 0.005）。
尽管无BCR生存率较低，但有LNM的中国患者可从RP和辅助ADT中获益。淋巴结转移负担低的患者预后良好。
