Izol Volkan, Ok Fesih, Aslan Guven, Akdogan Bulent, Sozen Sinan, Ozden Ender, Celik Orcun, Muezzinoglu Talha, Turkeri Levent, Akdogan Nebil, Baltaci Sumer
Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey.
Department of Urology, Siirt Training and Research Hospital, Siirt, Turkey.
Prostate. 2022 May;82(7):763-771. doi: 10.1002/pros.24318. Epub 2022 Feb 21.
Pelvic lymph node dissection (PLND) is the gold standard method for lymph node staging in prostate cancer. We aimed to evaluate the effect of PLND combined with radical prostatectomy (RP) on oncological outcomes in D'Amico intermediate-risk prostate cancer (IRPC) patients.
Patients with D'Amico IRPC were included in the study. In the overall cohort and subgroups (biopsy International Society of Urological Pathology [ISUP] grade group 2 and 3), patients were divided into two groups as PLND and no-PLND. More extensive PLND, defined as a number of removed nodes (NRN) ≥ 75th percentile.
After exclusion, a total of 631 patients were included: 351 (55.6%) had PLND and 280 (44.4%) had no-PLND. The mean age was 63.1 ± 3.60 years. The median NRN was 8.0 (1.0-40.0). The mean follow-up period was 47.7 ± 37.5 months. The lymph node involvement (LNI) rate was 5.7% in the overall cohort, 3.9% in ISUP grade 2, and 10.8% in ISUP grade 3. Patients with PLND were associated with more aggressive clinicopathologic characteristics but no significant difference in biochemical recurrence-free survival (BCRFS) was found between patients with PLND and no-PLND (p = 0.642). In the subgroup analysis for ISUP grades 2 and 3, no significant difference in BCRFS outcomes was found in patients with PLND and No-PLND (p = 0.680 and p = 0.922). Also, PLND extent had no effect on BCRFS (p = 0.569). The multivariable Cox regression model adjusted for preoperative tumor characteristics revealed that prostate specific antigen (PSA) (HR: 1.18, 95% CI: 1.01-1.25; p = 0.048) was an independent predictor of biochemical recurrence (BCR). The optimum cut-off value for PSA, which can predict BCRFS, was assigned to be 7.81 ng/ml, with an AUC of 0.63 (95% CI: 0.571-0.688). The highest sensitivity and specificity were 0.667 and 0.549.
Overall and cancer-specific survival analyzes were not evaluated because not enough events were observed. Neither PLND nor its extent improved BCRFS outcomes in IRPC. The LNI rate is low in patients with biopsy ISUP grade 2 and the BCR rate is low in those with PSA < 7.81 ng/dl so PLND can be omitted in these IRPC patients.
盆腔淋巴结清扫术（PLND）是前列腺癌淋巴结分期的金标准方法。我们旨在评估PLND联合根治性前列腺切除术（RP）对达米科中危前列腺癌（IRPC）患者肿瘤学结局的影响。
纳入达米科IRPC患者进行研究。在总体队列和亚组（活检国际泌尿病理学会[ISUP]2级和3级）中，患者被分为PLND组和非PLND组。更广泛的PLND定义为切除淋巴结数量（NRN）≥第75百分位数。
排除后，共纳入631例患者：351例（55.6%）接受了PLND，280例（44.4%）未接受PLND。平均年龄为63.1±3.60岁。NRN中位数为8.0（1.0 - 40.0）。平均随访期为47.7±37.5个月。总体队列中的淋巴结转移（LNI）率为5.7%，ISUP 2级为3.9%，ISUP 3级为10.8%。接受PLND的患者具有更具侵袭性的临床病理特征，但PLND组和非PLND组患者的无生化复发生存期（BCRFS）无显著差异（p = 0.642）。在ISUP 2级和3级的亚组分析中，PLND组和非PLND组患者的BCRFS结局无显著差异（p = 0.680和p = 0.922）。此外，PLND范围对BCRFS无影响（p = 0.569）。针对术前肿瘤特征进行调整的多变量Cox回归模型显示，前列腺特异性抗原（PSA）（HR：1.18，95%CI：1.01 - 1.25；p = 0.048）是生化复发（BCR）的独立预测因子。可预测BCRFS的PSA最佳临界值设定为7.81 ng/ml，AUC为0.63（95%CI：0.571 - 0.688）。最高敏感性和特异性分别为0.667和0.549。
由于观察到的事件不足，未进行总体生存和癌症特异性生存分析。PLND及其范围均未改善IRPC患者的BCRFS结局。活检ISUP 2级患者的LNI率较低，PSA<7.81 ng/dl的患者BCR率较低，因此这些IRPC患者可省略PLND。
