对于切缘阴性的接受根治性前列腺切除术的患者，淋巴血管侵犯对淋巴结转移的影响。
Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin.
机构信息
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
BMC Cancer. 2017 May 8;17(1):321. doi: 10.1186/s12885-017-3307-4.
BACKGROUND
The association between lymphovascular invasion and lymphatic or hematogenous metastasis has been suspected, with conflicting evidence. We have investigated the association between the risk of biochemical recurrence and lymphovascular invasion in resection margin negative patients, as well as its association with lymph node metastasis.
METHODS
One thousand six hundred thirty four patients who underwent radical prostatectomy from 2005 to 2014 were selected. Patients with bone or distant organ metastasis at the time of operation were excluded. Survival analysis was performed to assess biochemical recurrence, metastasis and mortality risks by Kaplan-Meier analysis and multivariate Cox proportional hazard regression. Odds of lymph node metastasis were evaluated by Logistic regression.
RESULTS
LVI was detected in 118 (7.4%) patients. The median follow-up duration was 33.1 months. In the Kaplan-Meier analysis, lymphovascular invasion was associated with significantly increased 5-year and 10-year BCR rate (60.2% vs. 39.1%, 60.2% vs. 40.1%, respectively; p < 0.001), 10-year bone metastasis rate and cancer specific mortality (16.9% vs. 5.1%, p = 0.001; 6.8% vs. 2.7%, p = 0.034, respectively) compared to patients without LVI. When stratified by T stage and resection margin status, lymphovascular invasion resulted in significantly increased 10-year biochemical recurrence rate in T3 patients both with and without positive surgical margin (p = 0.008, 0.005, respectively). In the multivariate Cox regression model lymphovascular invasion resulted in 1.4-fold BCR risk and 1.7-fold metastasis risk increase (95% CI 1.045-1.749, 1.024-2.950; p = 0.022, 0.040, respectively). Lymphovascular invasion was revealed to be strongly associated with lymph node metastasis in the multivariate Logistic regression (OR 4.317, 95% CI 2.092-8.910, p < 0.001).
CONCLUSION
Lymphovascular invasion increases the risk of recurrence in T3 patients regardless of margin status, by accelerating lymph node metastasis and distant organ metastasis.
背景
淋巴管侵犯与淋巴或血行转移之间存在关联，但证据相互矛盾。我们研究了切缘阴性患者中淋巴血管侵犯与生化复发风险的关系，以及与淋巴结转移的关系。
方法
选择了 2005 年至 2014 年期间接受根治性前列腺切除术的 1634 名患者。排除手术时存在骨或远处器官转移的患者。通过 Kaplan-Meier 分析和多变量 Cox 比例风险回归进行生存分析，以评估生化复发、转移和死亡率风险。通过 Logistic 回归评估淋巴结转移的几率。
结果
118 名（7.4%）患者检测到 LVI。中位随访时间为 33.1 个月。在 Kaplan-Meier 分析中，淋巴血管侵犯与显著增加的 5 年和 10 年 BCR 率（60.2%比 39.1%，60.2%比 40.1%；p<0.001）、10 年骨转移率和癌症特异性死亡率（16.9%比 5.1%，p=0.001；6.8%比 2.7%，p=0.034）相关。与无 LVI 患者相比。当按 T 分期和切缘状态分层时，淋巴血管侵犯导致 T3 患者（无论切缘阳性与否）10 年生化复发率显著增加（p=0.008，0.005）。在多变量 Cox 回归模型中，淋巴血管侵犯导致 BCR 风险增加 1.4 倍，转移风险增加 1.7 倍（95%CI 1.045-1.749，1.024-2.950；p=0.022，0.040）。在多变量 Logistic 回归中，淋巴血管侵犯与淋巴结转移密切相关（OR 4.317，95%CI 2.092-8.910，p<0.001）。
结论
无论切缘状态如何，淋巴血管侵犯都会通过加速淋巴结转移和远处器官转移，增加 T3 患者的复发风险。
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