前列腺癌根治术后盆腔淋巴结清扫及阳性淋巴结对生化复发、二次治疗及生存的影响。
Influence of pelvic lymph node dissection and node-positive disease on biochemical recurrence, secondary treatment, and survival after radical prostatectomy in men with prostate cancer.
机构信息
Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA.
Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany.
出版信息
Prostate. 2021 Feb;81(2):102-108. doi: 10.1002/pros.24085. Epub 2020 Oct 19.
BACKGROUND
The benefit of pelvic lymph node dissection (PLND) at radical prostatectomy (RP) remains unclear given the low prevalence of known nodal disease (pN1) and concerns about its therapeutic utility.
OBJECTIVE
To characterize the impact of PLND and secondary treatment on oncologic outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study of men who underwent primary RP with PLND for prostate cancer (PCa) at our institution since 2003. Men stratified by nodal status.
OUTCOME MEASURES AND STATISTICAL ANALYSIS
Outcomes include biochemical recurrence-free survival (bRFS), overall survival, and PCa-specific mortality (PCSM). Multivariable Cox regression models used for each outcome.
RESULTS AND LIMITATIONS
Of 1,543 men who underwent primary RP, 174 (11%) had pN1 disease. Median follow-up was 34 months (interquartile range, 15-62). Seven-year outcomes were similar whether less than or ≥14 LNs dissected. Among node-positive patients, 29% had undetectable (UDT) prostate-specific antigen (PSA), 11% had UDT PSA + adjuvant therapy, and 60% had detectable PSA, and 7-year bRFS differed (75% for UDT PSA, 90% for UDT + adjuvant therapy, 38% for detectable PSA, p < .01). Survival outcomes did not differ. In multivariable analysis, detectable PSA (vs. UDT, HR 5.2, 95% CI 2.0-13.3) associated with worse bRFS. After salvage treatment, 7-year outcomes did not differ between groups. Study limited by retrospective review.
背景
鉴于已知淋巴结疾病（pN1）的低患病率和对其治疗效果的担忧，根治性前列腺切除术（RP）时行盆腔淋巴结清扫术（PLND）的获益仍不清楚。
目的
描述 PLND 和辅助治疗对肿瘤学结果的影响。
设计、设置和参与者：对 2003 年以来在我们机构接受 PLND 治疗前列腺癌（PCa）的患者进行的队列研究。根据淋巴结状态对患者进行分层。
观察指标和统计分析
主要观察终点为生化无复发生存率（bRFS）、总生存率和 PCa 特异性死亡率（PCSM）。采用多变量 Cox 回归模型对每个结局进行分析。
结果和局限性
在接受根治性前列腺切除术的 1543 例患者中，有 174 例（11%）患有 pN1 疾病。中位随访时间为 34 个月（四分位间距，15-62）。清扫淋巴结数＜14 个或≥14 个时，7 年的结果相似。在淋巴结阳性的患者中，29%的患者前列腺特异性抗原（PSA）检测不到（UDT），11%的患者 UDT PSA+辅助治疗，60%的患者 PSA 可检测到，7 年的 bRFS 有差异（UDT PSA 为 75%，UDT+辅助治疗为 90%，可检测 PSA 为 38%，p＜0.01）。生存结果无差异。多变量分析显示，可检测到 PSA（与 UDT 相比，HR 5.2，95%CI 2.0-13.3）与 bRFS 更差相关。在接受挽救性治疗后，各组之间 7 年的结局无差异。本研究受限于回顾性研究。
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