Zincke H, Utz D C, Thulé P M, Taylor W F
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Urology. 1987 Oct;30(4):307-15. doi: 10.1016/0090-4295(87)90290-1.
Three hundred six patients with adenocarcinoma of the prostate underwent pelvic lymphadenectomy and had Stage D1 (T0-3,N1-2,M0) disease; 171 patients underwent radical retropubic prostatectomy with or without immediate adjuvant therapy (hormonal or radiation or both) or conservative (hormonal or radiation or both) treatment alone (n = 135). Follow-up was one-half to eighteen and one-half years (mean, 5 yrs). Immediate adjuvant orchiectomy significantly (P = 0.01) improved survival (87.4% at 10 years) and nonprogression rates for patients who underwent radical prostatectomy, but not for those who had lymphadenectomy. Overall patient survival was significantly better (P = 0.005) after prostatectomy than lymphadenectomy. Residual disease (n = 43) in patients who underwent prostatectomy and received adjuvant treatment (orchiectomy or radiation or both) did not affect disease outcome. Bilateral pelvic lymphadenectomy and radical prostatectomy with immediate adjuvant orchiectomy provided survival comparable to the expected survival; conservative treatment alone was associated with rapid disease progression and poor survival and significantly (P = 0.02) higher local morbidity.
306例前列腺腺癌患者接受了盆腔淋巴结清扫术，病情为D1期（T0 - 3，N1 - 2，M0）；171例患者接受了耻骨后根治性前列腺切除术，部分患者接受或未接受即刻辅助治疗（激素治疗或放疗或两者联合），或仅接受保守治疗（激素治疗或放疗或两者联合）（n = 135）。随访时间为半年至18年半（平均5年）。即刻辅助睾丸切除术显著（P = 0.01）提高了接受根治性前列腺切除术患者的生存率（10年生存率为87.4%）和无进展率，但对接受淋巴结清扫术的患者无效。前列腺切除术后患者的总体生存率显著高于淋巴结清扫术（P = 0.005）。接受前列腺切除术并接受辅助治疗（睾丸切除术或放疗或两者联合）的患者中的残留病灶（n = 43）不影响疾病转归。双侧盆腔淋巴结清扫术和即刻辅助睾丸切除术的根治性前列腺切除术提供的生存率与预期生存率相当；单纯保守治疗与疾病快速进展、生存率低相关，且局部发病率显著更高（P = 0.02）。
