Al-Amiri Bashar, Lundin Fredrik, Waldén Mauritz
a Department of Surgery and Urology , Central Hospital , Karlstad , Sweden.
b Center for Clinical Research , County Council of Värmland , Karlstad , Sweden.
Scand J Urol. 2018 Apr;52(2):101-107. doi: 10.1080/21681805.2017.1382568. Epub 2017 Oct 12.
This study evaluated the outcome with a treatment strategy for high-risk prostate cancer (PCa) using extended pelvic lymph-node dissection (eLND) followed by external beam radiation therapy (EBRT) in lymph-node-positive (LNpos) and lymph-node-negative (LNneg) cases compared with the strategy with limited pelvic lymph-node dissection (lLND) and only giving EBRT to LNneg cases.
From 2000 to 2006, 124 men with high-risk PCa underwent lLND and initiated androgen deprivation therapy (ADT) before planned EBRT. LNpos patients were excluded from EBRT following the SPCG-7 study strategy (group I). From 2007 to 2013, 111 patients underwent eLND and started ADT before EBRT, and LNneg and most LNpos patients received EBRT (group II). Using Kaplan-Meier plots and multivariable Cox regression, biochemical recurrence-free, metastasis-free, cancer-specific survival and overall survival were compared during a 10 year follow-up.
PSA progression-free survival rates after 2, 4, 6, 8 and 10 years were 78%, 66%, 52%, 45% and 41% in group I, and 88%, 83%, 78%, 69% and 69% in group II (p < 0.001), respectively. Group II had a lower risk of PSA progression [hazard ratio (HR) = 0.43, 95% confidence interval (CI) 0.27,0.69, p = 0.001], metastasis development (HR = 0.51, 95% CI 0.27,0.97, p = 0.040) and overall mortality (HR = 0.49, 95% CI 0.26,0.92, p = 0.027), but not of PCa-specific death (HR = 0.45, 95% CI 0.19,1.08, p = 0.074).
A treatment strategy for high-risk PCa with eLND combined with EBRT in LNneg and LNpos cases may improve outcome compared to a strategy with lLND and offering EBRT only to LNneg cases but ADT to LNpos cases.
本研究评估了一种针对高危前列腺癌（PCa）的治疗策略的效果，该策略在淋巴结阳性（LNpos）和淋巴结阴性（LNneg）病例中采用扩大盆腔淋巴结清扫术（eLND），随后进行外照射放疗（EBRT），并与采用有限盆腔淋巴结清扫术（lLND）且仅对LNneg病例进行EBRT的策略进行比较。
2000年至2006年，124例高危PCa男性患者接受了lLND，并在计划的EBRT前开始雄激素剥夺治疗（ADT）。根据SPCG - 7研究策略，LNpos患者被排除在EBRT之外（第一组）。2007年至2013年，111例患者接受了eLND，并在EBRT前开始ADT，LNneg和大多数LNpos患者接受了EBRT（第二组）。使用Kaplan - Meier曲线和多变量Cox回归，在10年随访期间比较了无生化复发、无转移、癌症特异性生存和总生存情况。
第一组在2年、4年、6年、8年和10年后的无前列腺特异性抗原（PSA）进展生存率分别为78%、66%、52%、45%和41%，第二组分别为88%、83%、78%、69%和69%（p < 0.001）。第二组发生PSA进展的风险较低[风险比（HR）= 0.43，95%置信区间（CI）0.27,0.69，p = 0.001]，发生转移的风险较低（HR = 0.51，95% CI 0.27,0.97，p = 0.040），总死亡率较低（HR = 0.49，95% CI 0.26,0.92，p = 0.027），但前列腺癌特异性死亡风险无差异（HR = 0.45，95% CI 0.19,1.08，p = 0.074）。
与采用lLND且仅对LNneg病例进行EBRT而对LNpos病例进行ADT的策略相比，在LNneg和LNpos病例中采用eLND联合EBRT的高危PCa治疗策略可能改善治疗效果。
