Kodiyan Joyson, Guirguis Adel, Ashamalla Hani
Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Clin Genitourin Cancer. 2020 Oct;18(5):395-401.e8. doi: 10.1016/j.clgc.2020.03.008. Epub 2020 Mar 13.
Radical prostatectomy with pelvic lymph node dissection (PLND) is the standard of care for unfavorable risk prostate cancer. We investigated dissection practice patterns and their impact on overall survival using a large national database.
Men with prostate adenocarcinoma diagnosed between 2004 and 2013 were identified from the National Cancer Data Base. Disease was classified as either favorable or unfavorable on the basis of National Comprehensive Cancer Network guidelines. Minimum follow-up was 4 years. All patients received risk-appropriate surgery: prostatectomy with or without PLND. Prostatectomy alone and prostatectomy with PLND was propensity score matched within each risk cohort. Survival analysis included Kaplan-Meier statistics, Cox proportional hazards model, and multivariate logistic regression.
A total of 66,469 subjects met the inclusion criteria. Median (range) age was 63 (27-90) years. Median (range) follow-up was 59.53 (48-143.54) months. Within the cohort of patients with favorable risk disease, 51% did not undergo nodal dissection. Matched analysis demonstrated no difference in survival (P = .926). Within the cohort of patients with unfavorable risk disease, 39.2% did not receive nodal dissection. Matched analysis demonstrated that nodal dissection had superior survival (log-rank P = .002; hazard ratio = 0.624; 95% confidence interval, 0.466-0.835; P = .002). Greater odds of receiving nodal dissection included an open or robot-assisted approach compared to a laparoscopic approach, academic/research programs, and higher risk groups.
Although PLND is associated with a significant survival benefit in men with unfavorable risk prostate cancer, nearly 40% of patients with unfavorable risk disease did not receive PLND.
根治性前列腺切除术联合盆腔淋巴结清扫术（PLND）是高危前列腺癌的标准治疗方法。我们使用一个大型国家数据库调查了淋巴结清扫的实践模式及其对总生存期的影响。
从国家癌症数据库中识别出2004年至2013年间诊断为前列腺腺癌的男性患者。根据美国国立综合癌症网络指南，将疾病分为低危或高危。最短随访时间为4年。所有患者均接受了风险适配的手术：行或不行PLND的前列腺切除术。在每个风险队列中，对单纯前列腺切除术和联合PLND的前列腺切除术进行倾向评分匹配。生存分析包括Kaplan-Meier统计、Cox比例风险模型和多变量逻辑回归。
共有66469名受试者符合纳入标准。中位（范围）年龄为63（27-90）岁。中位（范围）随访时间为59.53（48-143.54）个月。在低危疾病患者队列中，51%未进行淋巴结清扫。匹配分析显示生存率无差异（P = 0.926）。在高危疾病患者队列中，39.2%未接受淋巴结清扫。匹配分析显示淋巴结清扫具有更好的生存率（对数秩检验P = 0.002；风险比 = 0.624；95%置信区间，0.466-0.835；P = 0.002）。接受淋巴结清扫的可能性更高的因素包括与腹腔镜手术相比的开放或机器人辅助手术方式、学术/研究项目以及更高风险组。
虽然PLND对高危前列腺癌男性患者具有显著的生存获益，但近40%的高危疾病患者未接受PLND。
