Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):347-354. doi: 10.1016/j.ijrobp.2016.10.016. Epub 2016 Oct 19.
To assess the efficacy of robotic-assisted laparoscopic sentinel lymph node (SLN) dissection (SLND) to select those patients with prostate cancer (PCa) who would benefit from additional pelvic external beam radiation therapy and long-term androgen deprivation therapy (ADT).
Radioisotope-guided SLND was performed in 224 clinically node-negative patients scheduled to undergo external beam radiation therapy. Patients with histologically positive SLNs (pN1) were also offered radiation therapy to the pelvic lymph nodes, combined with 3 years of ADT. Biochemical recurrence (BCR), overall survival, and metastasis-free (including pelvic and nonregional lymph nodes) survival (MFS) rates were retrospectively calculated. The Briganti and Kattan nomogram predictions were compared with the observed pN status and BCR.
The median prostate-specific antigen (PSA) value was 15.4 ng/mL (interquartile range [IQR] 8-29). A total number of 834 SLNs (median 3 per patient; IQR 2-5) were removed. Nodal metastases were diagnosed in 42% of the patients, with 150 SLNs affected (median 1; IQR 1-2). The 5-year BCR-free and MFS rates for pN0 patients were 67.9% and 87.8%, respectively. The corresponding values for pN1 patients were 43% and 66.6%. The PSA level and number of removed SLNs were independent predictors of BCR and MFS, and pN status was an additional independent predictor of BCR. The 5-year overall survival rate was 97.6% and correlated only with pN status. The predictive accuracy of the Briganti nomogram was 0.665. Patients in the higher quartiles of Kattan nomogram prediction of BCR had better than expected outcomes. The complication rate from SLND was 8.9%.
For radioisotope-guided SLND, the high staging accuracy is accompanied by low morbidity. The better than expected outcomes observed in the lower quartiles of BCR prediction suggest a role for SLN biopsy as a potential selection tool for the addition of pelvic radiation therapy and ADT intensification in pN1 patients.
评估机器人辅助腹腔镜前哨淋巴结（SLN）解剖术（SLND）选择前列腺癌（PCa）患者的疗效，这些患者将受益于额外的盆腔外束放射治疗和长期雄激素剥夺治疗（ADT）。
对 224 例临床淋巴结阴性拟行外束放射治疗的患者进行放射性同位素引导 SLND。对 SLN 组织学阳性（pN1）的患者也提供盆腔淋巴结放疗，并联合 3 年 ADT。回顾性计算生化复发（BCR）、总生存率和无转移（包括盆腔和非区域性淋巴结）生存率（MFS）。比较 Briganti 和 Kattan 列线图预测与观察到的 pN 状态和 BCR。
中位前列腺特异性抗原（PSA）值为 15.4ng/ml（四分位间距[IQR] 8-29）。共切除 834 个 SLN（中位数 3 个/患者；IQR 2-5）。42%的患者诊断为淋巴结转移，150 个 SLN 受累（中位数 1；IQR 1-2）。pN0 患者的 5 年 BCR 无复发生存率和 MFS 率分别为 67.9%和 87.8%。pN1 患者的相应值分别为 43%和 66.6%。PSA 水平和切除的 SLN 数量是 BCR 和 MFS 的独立预测因子，而 pN 状态是 BCR 的另一个独立预测因子。5 年总生存率为 97.6%，仅与 pN 状态相关。Briganti 列线图的预测准确性为 0.665。BCR 预测 Kattan 列线图较高四分位数的患者的预后优于预期。SLND 的并发症发生率为 8.9%。
放射性同位素引导 SLND 具有较高的分期准确性，同时发病率较低。在 BCR 预测较低四分位数观察到的优于预期的结果表明，SLN 活检作为一种潜在的选择工具，可能用于 pN1 患者中添加盆腔放疗和 ADT 强化。
