Department of Urology, Mayo Clinic, Rochester, Minnesota; Department of Biostatistics, Mayo Clinic, Rochester, Minnesota.
Department of Urology, Mayo Clinic, Rochester, Minnesota; Department of Biostatistics, Mayo Clinic, Rochester, Minnesota.
J Urol. 2017 Jul;198(1):86-91. doi: 10.1016/j.juro.2017.01.063. Epub 2017 Jan 24.
Long-term data supporting the role of primary tumor resection in node positive prostate cancer are lacking. We evaluated the impact of adding radical retropubic prostatectomy to surgical castration on long-term oncologic outcomes in pathological node positive prostate cancer.
We identified men who underwent pelvic lymphadenectomy and orchiectomy within 90 days for pathological node positive prostate cancer from 1966 to 1995. Men treated with radical retropubic prostatectomy in addition to orchiectomy were matched 1:1 to men who underwent orchiectomy alone based on age, year of surgery, clinical grade, clinical T stage, number of positive nodes and preoperative serum prostate specific antigen, the latter from 1987 and thereafter. Kaplan-Meier and Cox regression analyses were done to compare cancer specific and overall survival.
The matched cohort included 158 men with 79 in each group. Of men who underwent orchiectomy alone 76 died, including 60 of prostate cancer. Of patients treated with radical retropubic prostatectomy plus orchiectomy 70 died, including 28 of prostate cancer. On Kaplan-Meier analyses prostatectomy plus orchiectomy vs orchiectomy alone was associated with prolonged cancer specific survival (at 20 years 59% vs 18%, log rank p <0.001) and overall survival (at 20 years 22% vs 9%, log rank p <0.001). In Cox models prostatectomy plus orchiectomy vs orchiectomy alone was associated with improved cancer specific survival (HR 0.28, 95% CI 0.17-0.46, p <0.001) and overall survival (HR 0.48, 95% CI 0.34-0.66, p <0.001). Findings were similar in the subset with available preoperative prostate specific antigen values.
With lifelong followup in nearly the entire cohort, this study demonstrates that adding radical retropubic prostatectomy to surgical castration for pathological node positive prostate cancer is associated with improved cancer specific and overall survival. When technically feasible in well selected patients, aggressive locoregional resection should be considered for node positive prostate cancer as part of a multimodal approach.
缺乏支持局部肿瘤切除术在局部淋巴结阳性前列腺癌中作用的长期数据。我们评估了在局部淋巴结阳性前列腺癌中，在根治性前列腺切除术的基础上联合去势治疗对长期肿瘤学结局的影响。
我们从 1966 年至 1995 年确定了接受盆腔淋巴结清扫术和去势治疗且局部淋巴结阳性前列腺癌的男性患者。将根治性前列腺切除术联合去势治疗的患者与仅接受去势治疗的患者进行 1:1 匹配，匹配因素包括年龄、手术年份、临床分级、临床 T 分期、阳性淋巴结数量和术前前列腺特异性抗原，后者从 1987 年及以后开始记录。采用 Kaplan-Meier 分析和 Cox 回归分析比较癌症特异性和总生存率。
匹配队列包括 158 例患者，其中每组 79 例。仅接受去势治疗的患者中，76 例死亡，其中 60 例死于前列腺癌；接受根治性前列腺切除术联合去势治疗的患者中，70 例死亡，其中 28 例死于前列腺癌。Kaplan-Meier 分析显示，根治性前列腺切除术联合去势治疗与癌症特异性生存时间延长相关（20 年时，59% vs 18%，对数秩检验 p<0.001）和总生存时间延长相关（20 年时，22% vs 9%，对数秩检验 p<0.001）。Cox 模型分析显示，与仅接受去势治疗相比，根治性前列腺切除术联合去势治疗与癌症特异性生存时间改善相关（HR 0.28，95%CI 0.17-0.46，p<0.001）和总生存时间改善相关（HR 0.48，95%CI 0.34-0.66，p<0.001）。在有术前前列腺特异性抗原值的亚组中，结果相似。
在几乎整个队列中进行了终身随访，本研究表明，在局部淋巴结阳性前列腺癌中，在根治性前列腺切除术的基础上联合去势治疗可改善癌症特异性和总生存率。在选择合适的患者时，如果技术可行，应考虑积极的局部区域切除术作为多模式治疗的一部分。
