Wenzel Mike, Würnschimmel Christoph, Covas Moschovas Marcio, Nathan Arjun, Wagner Christian, Calleris Giorgio, Di Maida Fabrizio, Rivas Juan Gomez, Bravi Carlo Andrea, De Groote Ruben, Piramide Federico, Turri Filippo, Kowalczyk Keith, Sharma Gopal, Andras Iulia, Lambert Edward, Liakos Nikolaos, Darlington Danny, Paciotti Marco, Sorce Gabriele, Mandel Philipp, Galfano Antonio, Marra Giancarlo, Nathan Senthil, Dell'Oglio Paolo, Mottrie Alexandre, Chun Felix K H, Patel Vipul, Breda Alberto, Larcher Alessandro
Department of Urology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
World J Urol. 2025 May 9;43(1):288. doi: 10.1007/s00345-025-05586-5.
Surgical features associated with better cancer-control outcomes are under investigation for salvage radical prostatectomy patients undergoing robotic approaches.
The Junior ERUS/Young Academic Urologist Working Group in Robotics in Urology conducted a multicentric project to investigate the effect of lymph node dissection (LND) and pN stage on biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival (OS) outcomes in 444 robotic salvage radical prostatectomy (s-RARP) patients.
Of all patients, 63% underwent LND with a median of eight removed lymph nodes. Patients without LND more frequently underwent initial focal therapy (60% vs. 37%) and harbored higher pathological Gleason score 8-10 (both p ≤ 0.02). In BCR analyses, no differences were observed between patients with vs. without LND with 24-months BCR-free survival rates of 74.8% vs. 73.6%. In OS analyses, better OS for LND patients (HR: 0,39, p = 0.049) was observed with 60-months OS rates of 81.3% vs. 92.1% for no LND vs. LND. Of LND patients. 16% harbored pN1 stage, which was associated with worse BCR-free survival (HR: 2.0,p = 0.025) with 60-months BCR-free survival rates of 63% for pN0 vs. 49.6% for pN1. In MFS analyses, no difference between both groups were observed. In OS analyses, the observed differences did not reach statistical significance with 60-months OS rates of 93.4% for pN0 vs. 84.7% for pN1.
Rates of LND are relatively low in contemporary s-RARP patients and are more frequently performed in patients with worse characteristics. However, LND may be associated with better OS, while pN1 patients are associated with worse cancer-control outcomes.
对于接受机器人手术的挽救性根治性前列腺切除术患者，正在研究与更好的癌症控制结果相关的手术特征。
泌尿外科机器人领域的初级ERUS/青年学术泌尿外科医生工作组开展了一项多中心项目，以研究淋巴结清扫术（LND）和pN分期对444例机器人挽救性根治性前列腺切除术（s-RARP）患者的无生化复发（BCR）、无转移（MFS）和总生存（OS）结果的影响。
在所有患者中，63%接受了LND，中位切除淋巴结数为8个。未接受LND的患者更常接受初始局部治疗（60%对37%），且病理Gleason评分8-10更高（两者p≤0.02）。在BCR分析中，接受LND与未接受LND的患者之间未观察到差异，24个月无BCR生存率分别为74.8%和73.6%。在OS分析中，观察到LND患者的OS更好（HR：0.39，p=0.049），未接受LND与接受LND的患者60个月OS率分别为81.3%和92.1%。在接受LND的患者中，16%为pN1期，这与较差的无BCR生存率相关（HR：2.0，p=0.025），pN0和pN1患者的60个月无BCR生存率分别为63%和49.6%。在MFS分析中，两组之间未观察到差异。在OS分析中，观察到的差异未达到统计学意义，pN0和pN1患者的60个月OS率分别为93.4%和84.7%。
在当代s-RARP患者中LND率相对较低，且在特征较差的患者中更常进行LND。然而，LND可能与更好的OS相关，而pN1患者与较差的癌症控制结果相关。
