Maccio Livia, Barresi Valeria, Domati Federica, Martorana Eugenio, Cesinaro Anna Maria, Migaldi Mario, Iachetta Francesco, Ieni Antonio, Bonetti Luca Reggiani
Section of Pathology, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena and Reggio Emilia, Modena, Italy.
Department of Human Pathology, University of Messina, Messina, Italy.
Intern Emerg Med. 2016 Apr;11(3):399-404. doi: 10.1007/s11739-015-1375-5. Epub 2016 Feb 13.
To assess whether any relationship exists between the number of histologically examined lymph nodes and the detection of metastases in pelvic lymph node dissection (PLND) specimens taken from patients with radical prostatectomy (RP) for prostatic adenocarcinoma. 1690 cases of RP with PNLD were included in the study; 54 % of the patients were submitted to extended PLND (ePLND). Kaplan-Meier curves confirm the negative prognostic significance of nodal metastases on the overall patients' survival (P < 0.0001). Nodal metastases are significantly associated with older age of patients (P = 0.0466), higher pT status (P < 0.0001), higher Gleason score (P < 0.0001) and positive surgical margin (P < 0.0001). The frequency of nodal metastases is significantly increased in cases submitted to ePLND (P < 0.0001), presumably due to the significantly higher number of lymphnodes retrieved using this procedure (P < 0.0001). In addition, regardless of the extent of PLND procedure, entire histological examination of PLND specimens is significantly associated with a higher frequency of nodal metastases (P < 0.0001). When we considered only pN0 cases, 21 display adverse prognosis and died of disease during the follow-up. The number of pelvic lymphnodes examined is significantly lower in the group of patients who die of the disease compared to that of survivors (P = 0.0448). In addition, Kaplan-Meier analysis shows that patients with 10 or fewer examined lymphnodes have significantly shorter disease-specific survival (P = 0.0151). Our findings confirm the negative prognostic significance of N status in prostate cancer. We suggest the examination of a minimum number of 10 lymphnodes, together with entire PLND processing, for accurate assessment of N status.
为评估在接受前列腺癌根治性前列腺切除术（RP）的患者的盆腔淋巴结清扫术（PLND）标本中，组织学检查的淋巴结数量与转移灶检测之间是否存在任何关联。本研究纳入了1690例接受RP及PNLD的病例；54%的患者接受了扩大盆腔淋巴结清扫术（ePLND）。Kaplan-Meier曲线证实了淋巴结转移对患者总体生存的负面预后意义（P<0.0001）。淋巴结转移与患者年龄较大（P = 0.0466）、较高的pT分期（P<0.0001）、较高的Gleason评分（P<0.0001）及手术切缘阳性（P<0.0001）显著相关。接受ePLND的病例中淋巴结转移频率显著增加（P<0.0001），推测是由于该手术方式获取的淋巴结数量显著更多（P<0.0001）。此外，无论PLND手术范围如何，对PLND标本进行完整的组织学检查均与较高的淋巴结转移频率显著相关（P<0.0001）。当我们仅考虑pN0病例时，21例显示预后不良并在随访期间死于疾病。与幸存者相比，死于疾病的患者组盆腔淋巴结检查数量显著更低（P = 0.0448）。此外，Kaplan-Meier分析表明，检查淋巴结数量为10个或更少的患者疾病特异性生存期显著更短（P = 0.0151）。我们的研究结果证实了N分期在前列腺癌中的负面预后意义。我们建议至少检查10个淋巴结，并对PLND标本进行完整处理，以准确评估N分期。
