Claps Francesco, Ramírez-Backhaus Miguel, Mir Maresma Maria Carmen, Gómez-Ferrer Álvaro, Mascarós Juan Manuel, Marenco Josè, Collado Serra Argimiro, Casanova Ramón-Borja Juan, Calatrava Fons Ana, Trombetta Carlo, Rubio-Briones Jose
Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain.
Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Int J Urol. 2021 May;28(5):566-572. doi: 10.1111/iju.14513. Epub 2021 Mar 5.
To evaluate whether indocyanine green guidance can improve the quality of extended pelvic lymph node dissection in patients undergoing radical prostatectomy.
A total of 214 patients underwent laparoscopic radical prostatectomy with indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection. These patients (group A) were matched 1:1 for clinical risk groups according to the National Comprehensive Cancer Network classification with patients who underwent the same procedure without fluorescence guidance (group B). Biochemical recurrence was defined as two consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan-Meier method and Cox regression models were used to identify predictors of biochemical recurrence.
The median number of retrieved nodes was significantly higher in group A (22 vs 14, P < 0.001). The rate of lymph node metastases was higher in group A (65.9% vs 34.1%, P = 0.01). Increasing the yield of lymph node dissection was independently and negatively correlated with the biochemical recurrence risk in both overall and pN-positive patients (hazard ratio 0.97, P = 0.03; and hazard ratio 0.95, P = 0.02). The 5-year biochemical recurrence-free survival rates were (75.8% vs 65.9, P = 0.09) and (54.1% vs 24.9%, P = 0.023) for group A and group B in the overall cohort and pN-positive cohort, respectively.
Indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection improves identification of lymphatic drainage, resulting in a higher number of lymph nodes and retrieved lymph node metastases, and allowing a more accurate local staging and a prolonged biochemical recurrence-free survival.
评估吲哚菁绿引导能否提高接受根治性前列腺切除术患者的扩大盆腔淋巴结清扫质量。
共有214例患者接受了吲哚菁绿引导下的淋巴结清扫加扩大盆腔淋巴结清扫的腹腔镜根治性前列腺切除术。根据美国国立综合癌症网络分类，这些患者（A组）与接受相同手术但无荧光引导的患者（B组）按临床风险组1:1匹配。生化复发定义为前列腺特异性抗原连续两次升高至少0.2 ng/mL。采用Kaplan-Meier法和Cox回归模型确定生化复发的预测因素。
A组回收淋巴结的中位数显著高于B组（22个对14个，P<0.001）。A组淋巴结转移率更高（65.9%对34.1%，P=0.01）。在总体患者和pN阳性患者中，增加淋巴结清扫的回收率与生化复发风险呈独立负相关（风险比0.97，P=0.03；风险比0.95，P=0.02）。在总体队列和pN阳性队列中，A组和B组的5年无生化复发生存率分别为（75.8%对65.9%，P=0.09）和（54.1%对24.9%，P=0.023）。
吲哚菁绿引导下的淋巴结清扫加扩大盆腔淋巴结清扫可改善淋巴引流的识别，导致更多的淋巴结及回收的淋巴结转移灶，实现更准确的局部分期并延长无生化复发生存期。
