Duquesne I, Champy C, Klap J, Chahwan C, Vordos D, de la Taille A, Salomon L
Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Prog Urol. 2019 Dec;29(16):981-988. doi: 10.1016/j.purol.2019.09.009. Epub 2019 Nov 14.
Adjuvant hormone therapy is the standard treatment after total prostatectomy with positive lymph node. However, this treatment has side effects and at the time of the PSA era and extensive lymph node dissection, this principle is questioned. The aim of this study is to describe the oncological characteristics of patients that may explain the delay in introducing hormone therapy in patients with positive lymph node.
Monocentric, retrospective study of 161 patients from November 1988 to February 2018 in a single French University Hospital, having undergone radical prostatectomy with positive lymph nodes on pathology. For each patient, preoperative data (age, clinical stage, biopsy results, d'Amico classification) and postoperative data (pathological results, number of lymph nodes removed, number of positive lympnodes, recurrence free survival, specific survival and overall survival) were collected. The date of introduction of hormone therapy was noted and survival without hormonal therapy was established according to the Kaplan Meier curve. The pre- and post-operative oncological factors that could influence hormone therapy introduction were investigated with Chi and Student tests (statistically significant when P<0.05).
The mean number of lymph nodes removed was 12 [1-40]. The mean number of positive lymph nodes was 2.5 [1-24], the mean percentage of positive lymph nodes was 25% (2.5-100). After a mean follow-up of 95 months (3-354), 88 patients (54.6%) had no hormonal treatment. The average time to hormonal treatment was 40 months [0-310]. At 3 years, survival without hormone therapy was 52% and 51% at 5 years. Only the percentage of positive lymphnodes appeared to be a significant predictor of the introduction of hormone therapy. (29.32% vs. 21.99%, P=0.047). Hormone-free survival was significantly higher in patients with lymph node involvement less than 25% (P<0.0001) or with less than 2 positive lymph nodes (P=0.0294).
Lymph node invasion is a factor of poor prognosis after total prostatectomy and leads to introduce hormone therapy. Our study identified the percentage and number of positive lymph nodes as factors that identify patients who may be delayed in introducing this hormone therapy.
辅助激素治疗是淋巴结阳性的前列腺癌根治术后的标准治疗方法。然而，这种治疗存在副作用，在前列腺特异抗原（PSA）时代及广泛淋巴结清扫的情况下，这一原则受到质疑。本研究的目的是描述那些可能解释淋巴结阳性患者延迟引入激素治疗的肿瘤学特征。
对1988年11月至2018年2月在法国一家大学医院接受前列腺癌根治术且术后病理显示淋巴结阳性的161例患者进行单中心回顾性研究。收集每位患者的术前数据（年龄、临床分期、活检结果、达米科分类）和术后数据（病理结果、切除淋巴结数量、阳性淋巴结数量、无复发生存率、特异性生存率和总生存率）。记录激素治疗开始日期，并根据Kaplan-Meier曲线确定无激素治疗的生存率。采用卡方检验和t检验研究术前和术后可能影响激素治疗引入的肿瘤学因素（P<0.05时有统计学意义）。
切除淋巴结的平均数量为12个[1-40个]。阳性淋巴结的平均数量为2.5个[1-24个]，阳性淋巴结的平均百分比为25%（2.5%-100%）。平均随访95个月（3-354个月）后，88例患者（54.6%）未接受激素治疗。激素治疗的平均时间为40个月[0-310个月]。3年时，无激素治疗的生存率为52%，5年时为51%。只有阳性淋巴结百分比似乎是激素治疗引入的显著预测因素。（29.32%对21.99%，P=0.047）。淋巴结受累少于25%（P<0.0001）或阳性淋巴结少于2个（P=0.0294）的患者无激素生存期显著更长。
淋巴结侵犯是前列腺癌根治术后预后不良的一个因素，并导致引入激素治疗。我们的研究确定阳性淋巴结的百分比和数量是识别可能延迟引入这种激素治疗的患者的因素。
3级。
