Flammia Rocco Simone, Hoeh Benedikt, Chierigo Francesco, Hohenhorst Lukas, Sorce Gabriele, Tian Zhen, Leonardo Costantino, Graefen Markus, Terrone Carlo, Saad Fred, Shariat Shahrokh F, Briganti Alberto, Montorsi Francesco, Chun Felix K H, Gallucci Michele, Karakiewicz Pierre I
Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Quebec, Canada.
Curr Urol. 2022 Dec;16(4):191-196. doi: 10.1097/CU9.0000000000000132. Epub 2022 Aug 22.
The National Comprehensive Cancer Network (NCCN) guidelines recommend pelvic lymph node dissection (PLND) in NCCN high- and intermediate-risk prostate cancer patients. We tested for PLND nonadherence (no-PLND) rates within the Surveillance Epidemiology and End Results (2010-2015).
We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria (n = 23,495). Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups, race/ethnicity, geographic distribution, and year of diagnosis.
Overall, the no-PLND rate was 26%; it was 41%, 25%, and 11% in the NCCN intermediate favorable, intermediate unfavorable, and high-risk prostate cancer patients, respectively ( < 0.001). Over time, the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup. Georgia exhibited the highest no-PLND rate (49%), whereas New Jersey exhibited the lowest (15%). Finally, no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup, where Asians exhibited the lowest no-PLND rate (20%) versus African Americans (27%) versus Whites (26%) versus Hispanic-Latinos (25%).
The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order. Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination. In all the NCCN risk subgroups, the no-PLND rates decreased over time.
美国国立综合癌症网络（NCCN）指南推荐对NCCN高危和中危前列腺癌患者进行盆腔淋巴结清扫术（PLND）。我们在监测、流行病学和最终结果（2010 - 2015年）中检测了PLND未依从率（未行PLND）。
我们确定了所有符合NCCN PLND指南标准的根治性前列腺切除术患者（n = 23495）。将PLND的未依从率制成表格，并根据NCCN风险亚组、种族/族裔、地理分布和诊断年份进一步分层。
总体而言，未行PLND率为26%；在NCCN中危有利、中危不利和高危前列腺癌患者中，该率分别为41%、25%和11%（<0.001）。随着时间的推移，整个队列以及每个NCCN风险亚组中的未行PLND率均下降。佐治亚州的未行PLND率最高（49%），而新泽西州最低（15%）。最后，仅在NCCN中危不利亚组中记录到未行PLND的种族/族裔差异，其中亚洲人的未行PLND率最低（20%），非裔美国人（27%）、白人（26%）和西班牙裔/拉丁裔（25%）。
NCCN高危患者的未行PLND率最低，其次依次为NCCN中危不利和中危有利风险患者。我们的研究结果表明，未行PLND率出人意料地升高的差异值得进一步研究。在所有NCCN风险亚组中，未行PLND率随时间下降。
