淋巴结转移前列腺癌患者根治性前列腺切除术后的中期肿瘤学结果。

Mid-term oncologic outcomes of radical prostatectomy in lymph node metastatic prostate cancer patients.

机构信息

Department of Urology, Hôpital Nord, AP-HM, Marseille, France.

出版信息

Prog Urol. 2023 Aug;33(8-9):437-445. doi: 10.1016/j.purol.2023.05.001. Epub 2023 May 27.

DOI:10.1016/j.purol.2023.05.001

PMID:37248105

Abstract

OBJECTIVES

Lymph node invasion (LNI) has been reported in 10-15% of pelvic lymph node dissection during radical prostatectomy (RP). The objective of this study was to describe the mid-term oncological outcomes in prostate cancer (PCa) patients with metastatic lymph node.

METHODS

We conducted a retrospective study at two French referral centers including consecutive cN0 PCa patients who underwent RP and extended pelvic lymph node dissection and had lymph node metastases on final pathological analysis (pN1) between January 2000 and May 2020. Follow-up was per institution, which generally included a PSA level measurement every 3 to 12 months for 5 years and annually thereafter.

RESULTS

A total of 123 patients were included: two (1.6%) low-risk, 64 (52%) intermediate-risk and 57 (46.4%) high-risk PCa according to the D'Amico risk classification. The median number of nodes removed and metastatic nodes per patient was 15 (IQR 11-22) and 1 (IQR 1-2), respectively. Adverse pathological features, i.e., ≥pT3a stage, ISUP grade ≥3, and positive surgical margins were reported in 113 (91.9%), 103 (83.7%), and 73 (59%) of cases, respectively. Postoperative treatment was administered in 104 patients, including radiotherapy alone (n=6), androgen deprivation therapy alone (n=27) or combination with androgen deprivation therapy and radiotherapy (n=71). The mean follow-up was 42.7 months. The estimated 3-year biochemical-free survival, clinical recurrence-free survival, and cancer-specific survival was 66% and 85% and 98.8%, respectively. In Cox regression analysis, the number of metastatic nodes was associated with clinical recurrence (P=0.04) and a persistently elevated PSA with biochemical recurrence (P<0.001).

CONCLUSION

The management of lymph node metastatic PCa patients is challenging. Risk stratification of node-positive patients, based on postoperative PSA levels and pathologic features being identified, should help physicians determine which patient would best benefit from multimodal treatment.

摘要

目的

据报道，在根治性前列腺切除术（RP）中，10-15%的患者存在淋巴结侵犯（LNI）。本研究的目的是描述转移性淋巴结前列腺癌（PCa）患者的中期肿瘤学结果。

方法

我们在法国的两个转诊中心进行了一项回顾性研究，纳入了 2000 年 1 月至 2020 年 5 月期间连续接受 RP 和扩大盆腔淋巴结清扫术且最终病理分析（pN1）存在淋巴结转移的 cN0 PCa 患者。随访由各机构进行，通常包括 5 年内每 3-12 个月测量一次 PSA 水平，此后每年测量一次。

结果

共纳入 123 例患者：根据 D'Amico 风险分类，2 例（1.6%）为低危、64 例（52%）为中危和 57 例（46.4%）为高危 PCa。患者淋巴结切除的中位数和每个患者的转移性淋巴结中位数分别为 15（IQR 11-22）和 1（IQR 1-2）。113 例（91.9%）、103 例（83.7%）和 73 例（59%）患者分别存在不良病理特征，即≥pT3a 期、ISUP 分级≥3 和阳性切缘。104 例患者接受了术后治疗，包括单纯放疗（n=6）、单独雄激素剥夺治疗（n=27）或联合雄激素剥夺治疗和放疗（n=71）。平均随访时间为 42.7 个月。估计的 3 年生化无复发生存率、临床无复发生存率和癌症特异性生存率分别为 66%、85%和 98.8%。在 Cox 回归分析中，转移性淋巴结的数量与临床复发相关（P=0.04），持续升高的 PSA 与生化复发相关（P<0.001）。