Preisser Felix, Bandini Marco, Marchioni Michele, Nazzani Sebastiano, Tian Zhe, Pompe Raisa S, Fossati Nicola, Briganti Alberto, Saad Fred, Shariat Shahrokh F, Heinzer Hans, Huland Hartwig, Graefen Markus, Tilki Derya, Karakiewicz Pierre I
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Prostate. 2018 May;78(6):469-475. doi: 10.1002/pros.23491. Epub 2018 Feb 19.
To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP).
Within the Surveillance, Epidemiology, and End results (SEER) database (2004-2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN.
In 28 147 RP and PLND patients without LNI, 67.3% versus 32.7% exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1%), GS ≥8 (25.7 vs 22.4%), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1%). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1% for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5%.
More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals.
评估盆腔淋巴结清扫术（PLND）范围对接受根治性前列腺切除术（RP）且无淋巴结转移（LNI）的前列腺癌（PCa）患者癌症特异性死亡率（CSM）的影响。
在监测、流行病学和最终结果（SEER）数据库（2004 - 2014年）中，我们确定了具有达米科中危或高危特征且接受了PLND的RP患者，且无LNI证据。首先，多变量逻辑回归模型对更广泛PLND的预测因素进行测试，更广泛PLND定义为切除淋巴结计数（NRN）≥第75百分位数。其次，Kaplan - Meier分析和多变量Cox回归模型测试NRN≥第75百分位数对CSM的影响。最后，使用连续编码的NRN重复生存分析。
在28147例接受RP和PLND且无LNI的患者中，67.3%与32.7%表现出达米科中危或高危特征。NRN的中位数为6（四分位间距3 - 10），第75百分位数定义为NRN≥11的患者。NRN≥11的患者cT2/3期发生率更高（29.8%对26.1%），GS≥8的发生率更高（25.7%对22.4%），且分别更频繁地表现出达米科高危特征（34.6%对32.1%）。在预测更广泛PLND（NRN≥11）概率的多变量逻辑回归模型中，更高的活检GS、更高的cT分期、更高的PSA、更近的诊断年份以及更年轻的诊断年龄是独立预测因素。RP后72个月，NRN≥11和NRN≤10的患者无CSM生存率分别为99.5%和98.1%，在对所有协变量进行调整后，风险比为0.50（P = 0.01）。同样，连续编码的NRN达到独立预测因素地位（风险比：0.955，P = 0.01），即每多切除一个淋巴结，CSM风险降低4.5%。
RP时更广泛的PLND可提供更好的分期信息，因此与无LNI证据的达米科中危和高危PCa患者较低的CSM相关。因此，对于此类患者应推荐更广泛的PLND。
