Nagaya Naoya, Chua Kevin J, Sterling Joshua, Horie Shigeo, Kim Isaac Y
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, NJ, United States.
Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Prostate Int. 2023 Jun;11(2):107-112. doi: 10.1016/j.prnil.2022.12.005. Epub 2022 Dec 21.
extended pelvic lymph node dissection (ePLND) increases the detection rate of lymph node positive prostate cancer compared to a standard pelvic lymph node dissection (sPLND). However, improvement of patient outcomes remains questionable. Here we report and compare 3-year postoperative PSA recurrence rates between patients that underwent sPLND versus ePLND at the time of prostatectomy.
162 patients received a sPLND (which involvedremoval of periprostatic, external iliac, and obturator lymph nodes bilaterally), and 142 patients received an ePLND (which involved removal of periprostatic, external iliac, obturator, hypogastric, and common iliac nodes bilaterally). Decision to undergo ePLND versus sPLND at our institution was changed in 2016 based on the National Comprehensive Cancer Network guideline. The median follow-up time was 7 and 3 years for sPLND and ePLND patients, respectively. All node-positive patients were offered adjuvant radiotherapy. Kaplan-Meier analysis was carried out to assess the impact of a PLND on early postoperative PSA progression-free survival. Subgroup analyses were done for node-negative and node-positive patients, as well as Gleason score.
Gleason score and T stage were not significantly different between patients who received an ePLND and sPLND. The pN1 rate for ePLND and sPLND were 20% (28/142) and 6% (10/162), respectively. There was no difference in the use of adjuvant treatments in the pN0 patients. Significantly, more ePLND pN1 patients received adjuvant androgen deprivation therapy (25/28 vs. 5/10 = 0.012) and radiation (27/28 vs. 4/10 = 0.002). Yet, no difference in biochemical recurrence between ePLND and sPLND was observed ( = 0.44). This remained true in subgroup analyses of node-positive ( = 0.26), node-negative ( = 0.78), Gleason Score 6-7 ( = 0.51), and Gleason Score 8-10 ( = 0.77).
PLND provided no additional therapeutic benefit, even though ePLND patients were significantly more likely to have node-positive disease and undergo adjuvant treatment, compared to a sPLND.
与标准盆腔淋巴结清扫术（sPLND）相比，扩大盆腔淋巴结清扫术（ePLND）可提高淋巴结阳性前列腺癌的检出率。然而，患者预后是否改善仍存在疑问。在此，我们报告并比较前列腺切除术时接受sPLND与ePLND的患者术后3年的PSA复发率。
162例患者接受了sPLND（双侧切除前列腺周围、髂外和闭孔淋巴结），142例患者接受了ePLND（双侧切除前列腺周围、髂外、闭孔、下腹和髂总淋巴结）。根据美国国立综合癌症网络指南，2016年我院决定接受ePLND与sPLND的标准发生了变化。sPLND和ePLND患者的中位随访时间分别为7年和3年。所有淋巴结阳性患者均接受辅助放疗。采用Kaplan-Meier分析评估PLND对术后早期PSA无进展生存期的影响。对淋巴结阴性和阳性患者以及Gleason评分进行亚组分析。
接受ePLND和sPLND的患者之间，Gleason评分和T分期无显著差异。ePLND和sPLND的pN1率分别为20%（28/142）和6%（10/162）。pN0患者在辅助治疗的使用上没有差异。值得注意的是，更多的ePLND pN1患者接受了辅助雄激素剥夺治疗（25/28 vs. 5/10 = 0.012）和放疗（27/28 vs. 4/10 = 0.002）。然而，未观察到ePLND和sPLND之间生化复发的差异（= 0.44）。在淋巴结阳性（= 0.26）、淋巴结阴性（= 0.78）、Gleason评分6-7（= 0.51）和Gleason评分8-10（= 0.77）的亚组分析中也是如此。
尽管与sPLND相比，ePLND患者淋巴结阳性疾病和接受辅助治疗的可能性显著更高，但PLND并没有提供额外的治疗益处。
