Porcaro Antonio B, Tafuri Alessandro, Sebben Marco, Processali Tania, Pirozzi Marco, Amigoni Nelia, Rizzetto Riccardo, Shakir Aliasger, Cacciamani Giovanni E, Brunelli Matteo, Siracusano Salvatore, Cerruto Maria Angela, Artibani Walter
Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy -
Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy.
Minerva Urol Nefrol. 2019 Oct;71(5):516-523. doi: 10.23736/S0393-2249.19.03401-5. Epub 2019 Jun 21.
The aim of this study was to investigate the risk factors contributing to multiple lymph node invasion (LNI) in patients with prostate cancer (PCa) undergoing extended pelvic lymph node dissection (ePLND) during robot assisted radical prostatectomy (RARP).
A total of 211 patients who underwent RARP and ePNLD from June 2013 to March 2017 were classified according to lymph node status in the surgical specimen (absent, single or multiple). Risk factors of LNI were evaluated by the multinomial logistic regression model. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the efficacy of factors and model evaluation.
On multivariate analysis, the risk of multiple LNI, was independently increased by Body Mass Index (BMI) (odds ratio [OR] 1.194; P=0.026) and prostate-specific antigen (PSA) (OR=1.089; P=0.014) when compared to patients without LNI. ROC curves indicated that both BMI (AUC=0.702) and PSA (AUC=0.732) had fair discrimination power. For each unit of increase in PSA, the odds of multiple lymph node invasion increased by 8.9% and for each unit increase of BMI, the odds of multiple LNI increased by 19.4%.
The risk of multiple LNI was independently predicted by PSA and BMI with fair discrimination power.
本研究旨在调查在机器人辅助根治性前列腺切除术（RARP）期间接受扩大盆腔淋巴结清扫术（ePLND）的前列腺癌（PCa）患者发生多组淋巴结转移（LNI）的危险因素。
对2013年6月至2017年3月期间接受RARP和ePNLD的211例患者，根据手术标本中的淋巴结状态（无、单个或多个）进行分类。采用多项逻辑回归模型评估LNI的危险因素。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估各因素的效能及模型评估。
多因素分析显示，与无LNI的患者相比，体重指数（BMI）（比值比[OR] 1.194；P = 0.026）和前列腺特异性抗原（PSA）（OR = 1.089；P = 0.014）独立增加多组LNI的风险。ROC曲线表明，BMI（AUC = 0.702）和PSA（AUC = 0.732）均具有较好的鉴别能力。PSA每增加一个单位，多组淋巴结转移的几率增加8.9%，BMI每增加一个单位，多组LNI的几率增加19.4%。
PSA和BMI具有较好的鉴别能力，可独立预测多组LNI的风险。
