Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China.
Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, China.
Int J Clin Oncol. 2020 Dec;25(12):2115-2121. doi: 10.1007/s10147-020-01758-y. Epub 2020 Aug 3.
The value of pelvic lymphadenectomy during radical prostatectomy (RP) remains controversial. This study aims to test the effects of the number of removed lymph nodes (RLN), positive nodes (pLN), and pLN ratio (pLNR) on cancer-specific survival (CSS) in patients with node-positive prostate cancer (PCa).
A total of 2458 patients with a greater than 5% probability of lymph node invasion according to the updated Briganti nomogram who harboured pathologically confirmed positive nodes in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were identified. Multivariable Cox regression with forward stepwise selection was performed to identify independent risk factors for CSS. Maximally selected rank statistics were used to determine the most informative cut-off value for pLN and pLNR.
The median pLN counts and RLN in the study were two (interquartile range [IQR] 1- 3) and 18 (IQR 15-23), respectively. The RLN counts could not predict CSS, while the higher pLN and pLNR were associated with worse CSS (hazard ratio [HR], 1.11; p < 0.001 and HR, 1.01; p < 0.001, respectively). Patients with ≤ 2 pLN or pLNR ≤ 20% had significantly better CSS than those with pLN > 2 or pLNR > 20% (HR, 1.38 (1.08-1.77); p = 0.009; HR, 1.77 (1.41-2.22); p < 0.001, respectively).
In patients with node-positive PCa, pelvic lymphadenectomy provides important information for staging, prognosis, and guiding after RP therapy; however, it does not play a therapeutic role. The pLN counts and pLNR were independent predictors of CSS.
根治性前列腺切除术（RP）中盆腔淋巴结清扫术的价值仍存在争议。本研究旨在检验在淋巴结阳性前列腺癌（PCa）患者中，移除的淋巴结数量（RLN）、阳性淋巴结（pLN）和 pLN 比（pLNR）对癌症特异性生存（CSS）的影响。
根据 Briganti 列线图，我们在 Surveillance, Epidemiology, and End Results 数据库中确定了 2004 年至 2015 年间 2458 例具有大于 5%淋巴结侵犯概率的患者，这些患者存在经病理证实的阳性淋巴结。采用逐步向前选择的多变量 Cox 回归分析确定 CSS 的独立危险因素。最大选择秩统计用于确定 pLN 和 pLNR 的最有效信息截断值。
研究中 pLN 计数和 RLN 的中位数分别为 2（四分位距 [IQR] 1-3）和 18（IQR 15-23）。RLN 计数不能预测 CSS，而较高的 pLN 和 pLNR 与较差的 CSS 相关（风险比 [HR]，1.11；p<0.001 和 HR，1.01；p<0.001）。pLN≤2 或 pLNR≤20%的患者与 pLN>2 或 pLNR>20%的患者相比，CSS 显著更好（HR，1.38（1.08-1.77）；p=0.009；HR，1.77（1.41-2.22）；p<0.001）。
在淋巴结阳性 PCa 患者中，盆腔淋巴结清扫术为分期、预后和指导 RP 治疗后提供了重要信息；然而，它并没有发挥治疗作用。pLN 计数和 pLNR 是 CSS 的独立预测因素。
