Seyedin Steven N, Mitchell Darrion L, Mott Sarah L, Russo J Kyle, Tracy Chad R, Snow Anthony N, Parkhurst Jessica R, Smith Mark C, Buatti John M, Watkins John M
Department of Radiation Oncology, Carver School of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA.
Pathol Oncol Res. 2019 Jan;25(1):209-215. doi: 10.1007/s12253-017-0349-5. Epub 2017 Oct 27.
The clinical impact of lymph node dissection extent remains undetermined in the contemporary setting, as reflected in care pattern variations. Despite some series demonstrating a direct relationship between number of lymph nodes identified and detection of nodal involvement, the correlation between lymph node yield and disease control or survival outcomes remains unclear. Patients with clinically localized prostate cancer, pre-RP PSA <30, and pT2-3a/N0 disease at RP were retrospectively identified from two databases for inclusion. Those who received pre- or post-RP radiotherapy or hormone therapy were excluded. Kaplan-Meier method was employed for survival probability estimation. Cox regression models were used to assess bRFS differences between subsets. From 2002 to 2010, 667 eligible patients were identified. The median age was 61 yrs. (range, 43-76), with median PSA 5.6 ng/dL (0.9-28.0). At RP, most patients had pT2c (64%) disease with Gleason Score (GS) ≤6 (43%) or 7 (48%); 218 (33%) patients had positive margins (M+). At median clinical and PSA follow-up of 96 and 87 months, respectively, 146 patients (22%) experienced PSA failure with an estimated bRFS of 81%/76% at 5/8 years. For patients who underwent LND, univariable analysis identified PSA (at diagnosis), higher GS (≥7, at biopsy or RP), intermediate/high risk stratification, M+ as adversely associated with bRFS (all p < 0.01). A higher number of LNs excised was not associated with improved bRFS for the entire cohort (HR = 0.97, p = 0.27), nor for any clinical risk stratum, biopsy GS, or RP GS subgroup. This study did not demonstrate an association between LN yield and bRFS in patients with clinically localized pT2-3a/pN0 prostate cancer managed with RP alone, either in the entire population or with substratification by clinical risk stratum or GS.
淋巴结清扫范围的临床影响在当代环境中仍未确定，这在护理模式的差异中有所体现。尽管一些系列研究表明所识别的淋巴结数量与淋巴结受累的检测之间存在直接关系，但淋巴结切除数量与疾病控制或生存结果之间的相关性仍不明确。从两个数据库中回顾性识别出临床局限性前列腺癌、RP前PSA<30且RP时为pT2 - 3a/N0疾病的患者纳入研究。排除接受RP前或RP后放疗或激素治疗的患者。采用Kaplan - Meier方法估计生存概率。使用Cox回归模型评估各亚组之间的bRFS差异。2002年至2010年，共识别出667例符合条件的患者。中位年龄为61岁（范围43 - 76岁），中位PSA为5.6 ng/dL（0.9 - 28.0）。在RP时，大多数患者患有pT2c（64%）疾病，Gleason评分（GS）≤6（43%）或7（48%）；218例（33%）患者切缘阳性（M+）。在中位临床随访96个月和PSA随访87个月时，146例患者（22%）出现PSA失败，5/8年时估计的bRFS为81%/76%。对于接受LND的患者，单因素分析确定诊断时的PSA、更高的GS（活检或RP时≥7）、中/高风险分层、M+与bRFS呈负相关（所有p<0.01）。切除的淋巴结数量较多与整个队列的bRFS改善无关（HR = 0.97，p = 0.27），在任何临床风险分层、活检GS或RP GS亚组中均无关联。本研究未证明在仅接受RP治疗的临床局限性pT2 - 3a/pN0前列腺癌患者中，淋巴结切除数量与bRFS之间存在关联，无论是在整个人群中还是按临床风险分层或GS进行亚组分析时。
