Schiffmann Jonas, Larcher Alessandro, Sun Maxine, Tian Zhe, Berdugo Jérémie, Leva Ion, Widmer Hugues, Lattouf Jean-Baptiste, Zorn Kevin C, Shariat Shahrokh F, Montorsi Francesco, Graefen Markus, Saad Fred, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Martini-Clinic, Prostate Cancer Centre Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy;; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
Can Urol Assoc J. 2016 Aug;10(7-8):269-276. doi: 10.5489/cuaj.3563.
Our aim was to assess adherence to National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) guidelines for pelvic lymph node dissection (PLND) at the time of either robot-assisted (RARP) or open radical prostatectomy (ORP).
We relied on the Surveillance, Epidemiology, and End Results-Medicare linked database and focused on localized prostate cancer (PCa) patients who were treated with either RARP or ORP between October 2008 and December 2009. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline-recommended PLND; and 2) probability of no PLND, when not guideline-recommended.
Among 5268 PCa patients, adherence to NCCN PLND guideline was 56.9% during RARP and 76.5% during ORP (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3‒0.6). AUA PLND guideline adherence was 68.1% during RARP and 82.4% during ORP (OR 0.7, 95% CI 0.5‒0.9). When PLND was not recommended, it was more frequently performed during ORP according to either NCCN (OR 3.7, 95% CI 3.5‒3.9) or AUA (OR 2.7, 95% CI 2.6‒2.8). According to the NCCN guideline, at recommended PLND in ORP patients, 6.3% harboured lymph node invasion (LNI) (number needed to treat [NNT] 16) vs. 3.2% at RARP (NNT 31). According to the AUA guideline, at recommended PLND in ORP patients, 12.3% harboured LNI (NNT 8) vs. 5.1% RARP (NNT 19).
Adherence to NCCN and AUA PLND guidelines was lower during RARP than during ORP when PLND was recommended. The rate of non-recommended PLND was also higher during ORP than during RARP. Technical considerations may be at play.
我们的目的是评估在机器人辅助根治性前列腺切除术（RARP）或开放性根治性前列腺切除术（ORP）时，对盆腔淋巴结清扫术（PLND）的美国国立综合癌症网络（NCCN）和美国泌尿外科学会（AUA）指南的遵循情况。
我们依据监测、流行病学和最终结果-医疗保险关联数据库，重点关注2008年10月至2009年12月期间接受RARP或ORP治疗的局限性前列腺癌（PCa）患者。分类和多变量逻辑回归分析针对两个终点：1）指南推荐的PLND概率；2）在未被指南推荐时未进行PLND的概率。
在5268例PCa患者中，RARP期间对NCCN PLND指南的遵循率为56.9%，ORP期间为76.5%（比值比[OR] 0.4，95%置信区间[CI] 0.3‒0.6）。RARP期间对AUA PLND指南的遵循率为68.1%，ORP期间为82.4%（OR 0.7，95% CI 0.5‒0.9）。当不推荐进行PLND时，根据NCCN（OR 3.7，95% CI 3.5‒3.9）或AUA（OR 2.7，95% CI 2.6‒2.8），在ORP期间进行PLND的情况更为频繁。根据NCCN指南，在ORP患者中推荐进行PLND时，6.3%存在淋巴结转移（LNI）（治疗所需人数[NNT] 16），而RARP时为3.2%（NNT 31）。根据AUA指南，在ORP患者中推荐进行PLND时，12.3%存在LNI（NNT 8），而RARP时为5.1%（NNT 19）。
当推荐进行PLND时，RARP期间对NCCN和AUA PLND指南的遵循率低于ORP期间。ORP期间不推荐的PLND发生率也高于RARP期间。技术因素可能起了作用。
