Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Polo Chirurgico Confortini, Piazzale Stefani 1, 37126, Verona, Italy.
Department of Neuroscience, Imaging and Clinical Sciences, ‟G. D'Annunzio″ University, Chieti-Pescara, Italy.
Int Urol Nephrol. 2020 Nov;52(11):2097-2105. doi: 10.1007/s11255-020-02554-3. Epub 2020 Jun 30.
To evaluate the association between obesity and risk of multiple lymph node metastases in prostate cancer (PCa) patients with clinically localized EAU intermediate and high-risk classes staged by extended pelvic lymph-node dissection (ePLND) during robot assisted radical prostatectomy (RARP).
373 consecutive PCa intermediate or high-risk patients were treated by RARP and ePLND. According to pathology results, extension of LNI was classified as absent (pN0 status) or present (pN1 status); pN1 was further categorized as one or more than one (multiple LNI) lymph node metastases. A logistic regression model (univariate and multivariate analysis) was used to evaluate the association between significant categorized clinical factors and the risk of multiple lymph nodes metastases.
Overall, after surgery lymph node metastases were detected in 51 patients (13.7%) of whom 22 (5.9%) with more than one metastatic lymph node and 29 (7.8%) with only one positive node. Comparing patients with one positive node to those without, EAU high-risk class only predicted risk of single LNI (OR = 2.872; p = 0.008). The risk of multiple lymph node metastases, when compared to cases without LNI, was independently predicted by BMI ≥ 30 (OR = 6.950; p = 0.002) together with BPC ≥ 50% (OR = 3.910; p = 0.004) and EAU high-risk class (OR = 6.187; p < 0.0001). Among metastatic patients, BMI ≥ 30 was the only factor associated with the risk of multiple LNI (OR = 5.250; p = 0.041).
In patients with clinically localized EAU intermediate and high-risk classes PCa who underwent RARP and ePLND, obesity was a risk factor of multiple LNI.
评估肥胖与经机器人辅助根治性前列腺切除术（RARP）行扩大盆腔淋巴结清扫术（ePLND）后临床局限性欧洲泌尿外科学会（EAU）中高危分级的前列腺癌（PCa）患者发生多个淋巴结转移的风险之间的关联。
对 373 例接受 RARP 和 ePLND 治疗的连续 PCa 中高危患者进行回顾性分析。根据病理结果，LNI 的扩展分为不存在（pN0 状态）或存在（pN1 状态）；pN1 进一步分为一个或多个（多个 LNI）淋巴结转移。使用逻辑回归模型（单因素和多因素分析）来评估显著分类的临床因素与多个淋巴结转移风险之间的关联。
总体而言，术后 51 例（13.7%）患者发现淋巴结转移，其中 22 例（5.9%）为多个阳性淋巴结，29 例（7.8%）为单个阳性淋巴结。与无阳性淋巴结的患者相比，仅 EAU 高危分级可预测单例 LNI 的风险（OR=2.872；p=0.008）。与无 LNI 的病例相比，BMI≥30（OR=6.950；p=0.002）、BPC≥50%（OR=3.910；p=0.004）和 EAU 高危分级独立预测发生多个淋巴结转移的风险（OR=6.187；p<0.0001）。在转移患者中，BMI≥30 是与多个 LNI 风险相关的唯一因素（OR=5.250；p=0.041）。
在接受 RARP 和 ePLND 治疗的临床局限性 EAU 中高危分级的 PCa 患者中，肥胖是多个 LNI 的危险因素。
