Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, and Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France.
Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy.
Eur Urol. 2019 Oct;76(4):493-504. doi: 10.1016/j.eururo.2018.10.041. Epub 2018 Oct 31.
Identification of early nodal recurrence after primary prostate cancer (PCa) treatment by functional imaging may guide metastasis-directed therapy such as salvage lymph node dissection (SLND).
The aim of this systematic review was to assess the oncological role and the safety of SLND in the era of modern imaging in case of exclusive nodal recurrence after primary PCa treatment with curative intent.
A systematic literature search in the PubMed and Cochrane databases was performed up to August 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Overall, 27 SLND series have been selected for synthesis.
Prostate-specific membrane antigen or choline positron emission tomography/computed tomography was the reference detection technique. SLND was performed by open or laparoscopic approach with <10% of grade 3 or more complication rate. Mean follow-up was 29.4 mo. Complete biochemical response after SLND was achieved in 13-79.5%of cases (mean 44.3%). The 2- and 5-yr biochemical progression-free survival rates ranged from 23% to 64% and from 6% to 31%, respectively. Fiver-year overall survival was approximately 84%. Main drawbacks limiting the interpretation of the effectiveness of SLND were the retrospective design of single-center series, heterogeneity between series in terms of adjuvant treatment, endpoints, definitions of progression and study population, as well as the absence of long-term follow-up.
A growing body of accumulated data suggests that SLND is a safe metastasis-directed therapy option in nodal recurrence after primary treatment. However, to date, high level of evidence is still missing to draw any clinically meaningful conclusion about the oncological impact of SLND on long-term endpoints.
When imaging identifies exclusive nodal recurrent prostate cancer, surgery directed to the positive lesions is safe and can offer at least a temporary biochemical response. The oncological role assessed by strong clinical endpoints remains uncertain.
通过功能成像识别原发性前列腺癌（PCa）治疗后的早期淋巴结复发，可能会指导转移性疾病导向治疗，如挽救性淋巴结清扫术（SLND）。
本系统评价的目的是评估在现代成像时代，对于具有治愈意图的原发性 PCa 治疗后仅发生淋巴结复发的患者，SLND 的肿瘤学作用和安全性。
根据系统评价和荟萃分析的首选报告项目，在 PubMed 和 Cochrane 数据库中进行了系统文献检索，检索时间截至 2018 年 8 月。总共选择了 27 项 SLND 系列进行综合分析。
前列腺特异性膜抗原或胆碱正电子发射断层扫描/计算机断层扫描是参考检测技术。SLND 通过开放或腹腔镜方法进行，并发症发生率<10%，且为 3 级或更高级别。平均随访时间为 29.4 个月。SLND 后完全生化缓解率为 13-79.5%（平均 44.3%）。2 年和 5 年的生化无进展生存率分别为 23%-64%和 6%-31%。5 年总生存率约为 84%。限制 SLND 有效性解释的主要缺陷是单中心系列的回顾性设计、系列间辅助治疗、终点、进展定义和研究人群的异质性，以及缺乏长期随访。
越来越多的累积数据表明，SLND 是原发性治疗后淋巴结复发的一种安全的转移性疾病导向治疗选择。然而，到目前为止，仍然缺乏高级别的证据来得出任何关于 SLND 对长期终点的肿瘤学影响的临床有意义的结论。
当影像学检查发现仅存在淋巴结复发性前列腺癌时，针对阳性病灶的手术是安全的，至少可以提供暂时的生化缓解。通过强烈的临床终点评估的肿瘤学作用仍不确定。
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