Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Urol Oncol. 2021 Apr;39(4):234.e1-234.e7. doi: 10.1016/j.urolonc.2020.10.010. Epub 2020 Oct 20.
The aim of this study was to investigate the impact of lymph-node involvement on oncological outcomes in patients with pathologically organ-confined prostate cancer (pT2 CaP) after radical prostatectomy (RP).
We retrospectively analyzed 9,631 pT2 CaP patients who underwent RP at a single institution between 1998 and 2018. Kaplan-Meier plots and Cox regression models (CRMs) assessed biochemical recurrence (BCR)-free survival and metastasis-free survival (MFS) according to N-stage. In subgroup analyses of N1 patients, Kaplan-Meier plots and CRMs were stratified according to adjuvant treatment.
Of 9,631 pT2 staged patients, 241 (2.5%) harbored lymph-node metastases after RP (pN1). The median follow-up was 60.8 months. No pT2 N1-staged patient died due to CaP. The 5-year BCR-free survival rates were 54.7 vs. 88.4% in pT2 N1 vs. pT2 N0 patients, respectively (P < 0.001). The 5-year MFS rates were 92.5 vs. 98.9% in pT2 N1 vs. pT2 N0 patients, respectively (P < 0.001). Within pT2 N1 patients, presence of ≥3 positive lymph nodes was an independent risk factor for BCR (hazard ratio [HR] 3.4, P < 0.001) and for metastatic progression (HR 1.7, P = 0.04). Finally, 3-year BCR-free survival was improved in pT2 N1 patients treated with adjuvant radiation therapy (87.1% vs. 63.7% for patients who received other treatment options [P < 0.001]).
Patients with pathologically organ-confined but lymph node-positive CaP exhibited favorable oncological outcomes after RP. Presence of ≥3 positive LNs predicted higher rates of BCR and metastatic progression. In consequence, in pT2 N1 patients treated with RP with ≥3 positive LNs, adjuvant treatment may be considered.9.
本研究旨在探讨接受根治性前列腺切除术（RP）的病理性局限于器官的前列腺癌（pT2CaP）患者淋巴结受累对肿瘤学结局的影响。
我们回顾性分析了 1998 年至 2018 年期间在一家机构接受 RP 的 9631 例 pT2CaP 患者。根据 N 期，使用 Kaplan-Meier 图和 Cox 回归模型（CRMs）评估生化复发（BCR）无复发生存和无转移生存（MFS）。在 N1 患者的亚组分析中，根据辅助治疗对 Kaplan-Meier 图和 CRMs 进行分层。
9631 例 pT2 分期患者中，241 例（2.5%）在 RP 后存在淋巴结转移（pN1）。中位随访时间为 60.8 个月。没有 pT2N1 分期的患者因前列腺癌而死亡。5 年 BCR 无复发生存率分别为 pT2N1 患者 54.7%和 pT2N0 患者 88.4%（P<0.001）。5 年 MFS 率分别为 pT2N1 患者 92.5%和 pT2N0 患者 98.9%（P<0.001）。在 pT2N1 患者中，存在≥3 个阳性淋巴结是 BCR 的独立危险因素（风险比 [HR]3.4，P<0.001）和转移进展的危险因素（HR1.7，P=0.04）。最后，接受辅助放疗的 pT2N1 患者 3 年 BCR 无复发生存率提高（87.1%vs.63.7%，接受其他治疗方案的患者[P<0.001]）。
接受 RP 的病理性局限于器官但淋巴结阳性的 CaP 患者表现出良好的肿瘤学结局。存在≥3 个阳性 LN 预测 BCR 和转移进展的发生率更高。因此，在接受 RP 治疗且存在≥3 个阳性 LN 的 pT2N1 患者中，可能需要考虑辅助治疗。
