Hoshi Senji, Hayashi Natuho, Kurota Yuuta, Hoshi Kiyotsugu, Muto Akinori, Sugano Osamu, Numahata Kenji, Bilim Vladimir, Sasagawa Isoji, Ohta Shoichiro
Department of Urology, Yamagata Prefectural Central Hospital, Yamagata, Yamagata 990-2292, Japan ; Department of Urology, Yamagata Tokushukai Hospital, Yamagata, Yamagata 990-0834, Japan.
Department of Urology, Yamagata Prefectural Central Hospital, Yamagata, Yamagata 990-2292, Japan.
Mol Clin Oncol. 2015 Sep;3(5):1085-1087. doi: 10.3892/mco.2015.601. Epub 2015 Jul 8.
Standard lymphadenectomy for prostate cancer is limited to the obturator lymph nodes (LNs), although the internal and external iliac LNs represent the primary landing zone for prostatic lymphatic drainage. We performed anatomically semi-extended pelvic lymph node dissection (PLND) to assess the incidence of LN metastasis in cases of clinically localized prostate cancer. A total of 730 consecutive patients underwent radical prostatectomy with either semi-extended PLND, comprising 6 selective fields, namely the external iliac, internal iliac and obturator LNs bilaterally, or standard LND (obturator LNs alone). A total of 131 patients undergoing semi-extended PLND were compared with 599 patients undergoing standard LND. The patients were stratified into high-risk [prostate-specific antigen (PSA)>20 ng/ml, Gleason score (GS)≥8], intermediate-risk (PSA 10-20 ng/ml, GS=4+3) and low-risk (PSA<10 ng/ml, GS≤3+4) subgroups. Following semi-extended LND, positive LNs were detected in 12/61 (20%) of the high-risk, 1/30 (3%) of the intermediate-risk and 0/40 (0%) of the low-risk cases. Following standard LND, positive LNs were detected in 13/182 (7%) of the high-risk, 1/164 (0.6%) of the intermediate-risk and 0/253 (0%) of the low-risk cases. In high-risk patients, the detection rate of LN metastasis was significantly higher following extended LND compared with standard LND (P<0.01). In 9 of 13 patients (69%), metastases were identified in the internal and external iliac regions, despite negative obturator LNs. There were no significant differences regarding intraoperative and postoperative complications or blood loss in the two groups. There was no lymphocele formation in patients undergoing either standard or semi-extended LND. Extended pelvic LND (PLND) is associated with a high rate of LN metastasis detection outside the fields of standard LND in cases with clinically localized prostate cancer. Therefore, LND including the internal and external iliac LNs should be performed in all patients with high-risk prostate cancer; however, in the low-risk group, PLND may be omitted.
前列腺癌的标准淋巴结清扫术仅限于闭孔淋巴结，尽管髂内和髂外淋巴结是前列腺淋巴引流的主要着陆区。我们进行了解剖学上的半扩大盆腔淋巴结清扫术（PLND），以评估临床局限性前列腺癌病例中淋巴结转移的发生率。共有730例连续患者接受了根治性前列腺切除术，其中包括半扩大PLND（包括6个选择性区域，即双侧髂外、髂内和闭孔淋巴结）或标准淋巴结清扫术（仅清扫闭孔淋巴结）。将131例行半扩大PLND的患者与599例行标准淋巴结清扫术的患者进行比较。患者被分为高危组[前列腺特异性抗原（PSA）>20 ng/ml， Gleason评分（GS）≥8]、中危组（PSA 10 - 20 ng/ml， GS = 4 + 3）和低危组（PSA<10 ng/ml， GS≤3 + 4）。在半扩大淋巴结清扫术后，高危组61例中有12例（20%）、中危组30例中有1例（3%）、低危组40例中无（0%）检测到阳性淋巴结。在标准淋巴结清扫术后，高危组182例中有13例（7%）、中危组164例中有1例（0.6%）、低危组253例中无（0%）检测到阳性淋巴结。在高危患者中，与标准淋巴结清扫术相比，扩大淋巴结清扫术后淋巴结转移的检出率显著更高（P<0.01）。在13例患者中的9例（69%）中，尽管闭孔淋巴结为阴性，但在髂内和髂外区域发现了转移灶。两组在术中及术后并发症或失血量方面无显著差异。行标准或半扩大淋巴结清扫术的患者均未形成淋巴囊肿。对于临床局限性前列腺癌病例，扩大盆腔淋巴结清扫术（PLND）与在标准淋巴结清扫术范围外检测到高比例的淋巴结转移相关。因此，所有高危前列腺癌患者均应进行包括髂内和髂外淋巴结的淋巴结清扫术；然而，在低危组中，可省略PLND。
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