Chalfin Heather J, Feng Zhaoyong, Trock Bruce J, Partin Alan W
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
Urology. 2017 Jun;104:143-149. doi: 10.1016/j.urology.2017.01.037. Epub 2017 Feb 21.
To examine nationwide patterns of lymph node dissection (LND) in men with D'Amico low-risk prostate cancer, including the rate of detected lymph node metastasis and factors associated with the decision to perform LND. Existing guidelines recommend against LND at the time of radical prostatectomy (RP) in low-risk men, yet this is still a common practice.
The 2013 National Cancer Database includes 1,208,180 cases of prostate cancer diagnosed between 2004 and 2013. Of these, 50,245 met D'Amico low-risk criteria, had complete clinicopathologic data, and underwent RP. Mixed effects multivariable logistic regression models were used to identify hospital and treatment characteristics independently associated with LND, extended LND, and the detection of lymph node metastasis.
A total of 20,556 men (40.9%) underwent LND and 4360 (8.7%) had extended LND. Lymph node metastasis was present in 76 cases (0.37%). On multivariable analysis, robotic vs open RP had odds ratio (OR) = 0.16 (0.14-0.17), P < .0001, for LND, and surgery at an academic center had OR = 1.76 (1.33-2.33), P < .0001, for LND. Men on Medicaid were less likely than the privately insured to undergo LND, and the highest earners were most likely to undergo LND. In multivariable analysis, race was significantly associated with lymph node metastasis, with black men having the highest rates (P < .0001).
LND is performed in nearly half of low-risk men, more commonly during open surgery at academic centers, yet metastasis is discovered less than 1% of the time. Guidelines suggest that percentage core involvement should be considered, but if the overall risk of metastasis is low, LND should not be performed.
研究全国范围内D’Amico低危前列腺癌男性患者的淋巴结清扫（LND）模式，包括检测到的淋巴结转移率以及与LND决策相关的因素。现有指南不建议在低危男性患者行根治性前列腺切除术（RP）时进行LND，但这仍是一种常见的做法。
2013年国家癌症数据库包含2004年至2013年间诊断的1,208,180例前列腺癌病例。其中，50,245例符合D’Amico低危标准，具有完整的临床病理数据，并接受了RP。采用混合效应多变量逻辑回归模型来确定与LND、扩大LND以及淋巴结转移检测独立相关的医院和治疗特征。
共有20,556名男性（40.9%）接受了LND，4360名（8.7%）接受了扩大LND。76例（0.37%）存在淋巴结转移。在多变量分析中，机器人辅助RP与开放RP相比，LND的比值比（OR）=0.16（0.14 - 0.17），P <.0001；在学术中心进行手术，LND的OR = 1.76（1.33 - 2.33），P <.0001。参加医疗补助计划的男性比参加私人保险的男性接受LND的可能性更小，收入最高的人群接受LND的可能性最大。在多变量分析中，种族与淋巴结转移显著相关，黑人男性的转移率最高（P <.0001）。
近一半的低危男性接受了LND，在学术中心进行开放手术时更为常见，但转移的发现率不到1%。指南建议应考虑癌芯累及百分比，但如果转移的总体风险较低，则不应进行LND。
