Sawada Atsuro, Nishimoto Koshiro, Akamatsu Shusuke, Kubota Masashi, Sumiyoshi Takayuki, Saito Ryoichi, Kurahashi Ryoma, Sekine Yuya, Negoro Hiromitsu, Shiraishi Yusuke, Iguchi Ryo, Nakashima Masakazu, Kokura Kazuki, Iwamura Hiroshi, Kohei Naoki, Shimatani Kimihiro, Kamoto Toshiyuki, Kobayashi Takashi, Goto Takayuki
Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Sci Rep. 2025 May 21;15(1):17680. doi: 10.1038/s41598-025-00926-2.
To elucidate the real-world oncological outcomes of robot-assisted radical prostatectomy (RARP) and effectiveness of extended pelvic lymph node dissection (ext-LDN) in the RARP era. Data from 8 194 patients who underwent RARP, including age, clinical T stage, prostate-specific antigen (PSA) before prostate cancer diagnosis (initial PSA), follow-up years, biopsied specimen grade group (GG), and whether they underwent lymph node dissection or not and presurgical androgen deprivation therapy, were recorded. Oncological outcomes among three risk groups (low, intermediate, and poor risks) were analyzed using Kaplan-Meier curves. In intermediate and poor risk cohorts, PSA failure-free, clinical recurrence-free, castration-resistant prostate cancer (CRPC)-free survival, and overall survival (OS) were compared between the ext-LDN groups and no or limited lymph node dissection (no-ltd-LND) groups before and after propensity matching for initial PSA, clinical stage, GG, and androgen deprivation therapy. Four survivals (PSA failure-free, clinical recurrence-free, CRPC-free survival, and OS) were noted among the three risk groups that generally reflected the risks. In comparison between ext-LDN and no-ltd-LND groups, propensity matching matched four factors. No significant difference was observed in the four survivals with or without ext-LDN. In the intermediate-risk, high-risk, and locally advanced cohorts (cT3-4), similar analyses were performed as the subanalyses; no significant difference was observed in the three subanalyses. We showed survival differences among the risk groups and that extended pelvic lymph node dissection has no oncological effectiveness using the largest patient cohort in the literature.
为阐明机器人辅助根治性前列腺切除术（RARP）的真实世界肿瘤学结局以及RARP时代扩大盆腔淋巴结清扫术（ext-LDN）的有效性。记录了8194例行RARP患者的数据，包括年龄、临床T分期、前列腺癌诊断前的前列腺特异性抗原（PSA）（初始PSA）、随访年限、活检标本分级组（GG），以及他们是否接受了淋巴结清扫、术前雄激素剥夺治疗。使用Kaplan-Meier曲线分析三个风险组（低、中、高风险）的肿瘤学结局。在中、高风险队列中，在对初始PSA、临床分期、GG和雄激素剥夺治疗进行倾向匹配前后，比较ext-LDN组与未行或有限淋巴结清扫（no-ltd-LND）组的无PSA失败、无临床复发、无去势抵抗性前列腺癌（CRPC）生存和总生存（OS）情况。在三个风险组中观察到四种生存情况（无PSA失败、无临床复发、无CRPC生存和OS），总体上反映了风险。在ext-LDN组和no-ltd-LND组的比较中，倾向匹配匹配了四个因素。有无ext-LDN的四种生存情况均未观察到显著差异。在中风险、高风险和局部晚期队列（cT3-4）中，作为亚分析进行了类似分析；在三项亚分析中均未观察到显著差异。我们使用文献中最大的患者队列表明了风险组之间的生存差异，并且扩大盆腔淋巴结清扫术没有肿瘤学有效性。
