摘要
目的:探讨盆腔淋巴结清扫术对术前淋巴结阴性的高危/极高危前列腺癌(PCa)的临床必要性。方法:收集2009年1月~2016年10月我院影像学淋巴结阴性并接受外科手术治疗的172例高危/极高危PCa患者临床病理资料。所有患者均在术后接受辅助内分泌治疗,其中79例接受前列腺癌根治术(RP)+盆腔淋巴结清扫术(淋巴结清扫组),93例术中仅行RP(未行淋巴结清扫组)。比较两组患者生化复发及并发症发生情况。结果:172例患者中位随访时间40.6个月,两组患者无生化复发生存期(BFS)比较差异无统计学意义(HR=1.06,95%CI:0.66~1.69,P=0.817)。随访期间,40例(23.3%)出现围手术期并发症,53例(30.8%)出现远期并发症。淋巴结清扫组的围手术期并发症发生率明显高于未行淋巴结清扫组(P<0.05),两组远期并发症发生率比较差异无统计学意义(P>0.05)。结论:在接受RP联合辅助内分泌治疗且术前影像学淋巴结阴性的高危/极高危PCa患者中,行盆腔淋巴结清扫术可能不会延长患者BFS,且会增加围手术期并发症发生率。淋巴结清扫对改善高危/极高危PCa患者预后的治疗价值仍需大宗前瞻性研究证实。
Objective：To explore the necessity of pelvic lymph node dissection（PLND）in patients with high-and very high-risk prostate cancer（PCa）treated with radical prostatectomy（RP）and adjuvant androgen deprivation therapy（ADT）.Method：The clinicopathological data of 172 patients with high-and very high-risk PCa who received RP from January 2009 to October 2016 were collected.Among the included patients,79 received RP and PLND,93 received RP alone,and all the patients were treated with adjuvant ADT after surgery.The difference in biochemical recurrence-free survival（BFS）and complications between two groups were compared.Result：The median follow-up period was 40.6 months.No significant difference in BFS was found between patients with or without PLND（HR：1.06,95%CI：0.66-1.69;P=0.817）.During the follow-up period,40 patients（23.3%）had perioperative complications and 53 patients（30.8%）developed long-term complications.The perioperative complication rate was higher in patients with PLND compared to patients without PLND（P0.05）.No statistical difference in long-term complication rate was found between two groups（P0.05）.Conclusion：PLND may not prolong BFS and is associated with more perioperative complication in high-and very high-risk PCa patients with negative radiological results treated with RP and adjuvant ADT.Prospective studies are needed to verify the therapeutic role of PLND in patients with high-and very high-risk PCa.
作者
陈俊儒
束坤鹏
姚晋
张浩然
柳建栋
魏强
李响
沈朋飞
曾浩
CHEN Junru;SHU Kunpeng;YAO Jin;ZHANG Haoran;LIU Jiandong;WEI Qiang;LI Xiang;SHEN Pengfei;ZENG Hao(Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China;Department of Radiology, West China Hospital, Siehuan University)
出处
《临床泌尿外科杂志》
2018年第4期260-264,共5页
Journal of Clinical Urology
基金
国家自然科学基金(编号81402110)
关键词
高危/极高危
前列腺癌
盆腔淋巴结清扫
无生化复发生存期
并发症
辅助内分泌治疗
high/very high-risk
prostate cancer
pelvic lymph node dissection
biochemical recurrence-free survival
complications
adjuvant androgen deprivation therapy
