摘要
目的探讨区域性淋巴结清扫治疗转移性去势抵抗性前列腺癌(mCRPC)的临床效果及安全性。方法回顾分析2015年8月至2021年5月于复旦大学附属肿瘤医院行区域性淋巴结清扫22例mCRPC患者的临床资料。22例均曾行根治性前列腺切除术并进入mCRPC阶段。患者行根治性前列腺切除术时平均年龄65.5(54~79)岁。从根治术至患者进展至mCRPC的中位时间为32(4~96)个月,从诊断mCRPC至行区域性淋巴结清扫的中位时间为4(1~43)个月。区域性淋巴结清扫前中位前列腺特异性抗原(PSA)为4.44(2.00~22.15)ng/ml。影像学检查均发现局限于盆腔或者腹膜后的转移性淋巴结,并均排除其他部位的转移;单纯盆腔淋巴结转移16例,腹膜后淋巴结转移3例,盆腔及腹膜后均有淋巴结转移3例。区域性淋巴结清扫前18例应用药物去势联合第一代抗雄药物治疗,4例采用药物去势联合阿比特龙治疗。根据转移淋巴结位置决定清扫范围,闭孔区淋巴结及髂外、髂内血管周围淋巴结转移者清扫范围包括髂外静脉和髂内静脉周围的纤维脂肪组织、闭孔区淋巴脂肪组织;髂总、盆底淋巴结转移者,在原有清扫范围的基础上增加髂总血管周围所有淋巴脂肪组织,至主动脉分叉;腹膜后淋巴结转移者,切除位于肾动脉和主动脉分叉之间所有淋巴脂肪组织。分析术后病理特征、手术并发症、术后PSA缓解率、PSA进展时间。结果本组22例中,6例行单侧盆腔淋巴结清扫,10例行双侧盆腔淋巴结清扫,3例同时行盆腔和腹膜后淋巴结清扫,3例行单纯腹膜后淋巴结清扫。病理结果示19例(86.3%)淋巴结阳性,平均每例清扫9.8(3~29)枚淋巴结,平均4.1(0~12)枚阳性。22例均在淋巴结清扫后继续沿用之前的内分泌治疗方案。术后并发症:7例淋巴漏;5例术后发热,其中1例通过体液培养证实存在盆腔细菌感染;1例因转移淋巴结侵犯血管导致术中大出血,术中予及时止�
Objective To observe the clinical effect and safety of regional lymph node dissection in metastatic castration resistant prostate cancer(mCRPC).Methods The clinical data of 22 patients with mCRPC who underwent regional lymph node dissection in our hospital from August 2015 to May 2021 were retrospectively analyzed.All patients had undergone radical prostatectomy and entered mCRPC,metastatic lymph nodes limited to pelvic or retroperitoneal without other metastasis were determined by PSMA-PET in 5 cases and PSMA-SPECT in 17 cases.The median time from radical surgery to mCRPC was 32(4-96)months,and the median time from discovery of mCRPC to regional lymph node dissection was 4(1-43)months.The median PSA before regional lymph node dissection was 4.44(2.00-22.15)ng/ml.Image of local examination showed pelvic lymph node metastasis in 16 cases,retroperitoneal lymph node metastasis in 3 cases,pelvic together with retroperitoneal lymph node metastasis in 3 cases.Before regional lymph node dissection,18 patients were treated with drug castration combined with first-generation antiandrogens,and 4 patients were treated with drug castration combined with abiraterone.The lymph node dissection range was determined according to the location of metastatic lymph nodes.Obturator lymph nodes and lymph node metastasis around external iliac and internal iliac vessels:the range of dissection includes fibrous adipose tissue around external iliac vein and internal iliac vein,and obturator lymph adipose tissue.Common iliac and pelvic floor lymph node metastasis:dissect lymphoid adipose tissue around common iliac vessels on the basis of the original dissection range as far as the aortic bifurcation.Retroperitoneal lymph node metastasis:remove all lymph node adipose tissue located between the bifurcation of renal artery and aorta.The PSA remission rate,PSA remission time,surgical complications and other relevant clinicopathological features were analyzed.Results Among the 22 cases,6 cases underwent unilateral pelvic lymph node dissection,10
作者
王弘恺
戴波
朱耀
林国文
秦晓健
叶定伟
Wang Hongkai;Dai Bo;Zhu Yao;Lin Guowen;Qin Xiaojian;Ye Dingwei(Department of Urology,Fudan University Shanghai Cancer Center,Department of Oncology,Fudan University Shanghai Medical College,Shanghai 200032,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第9期670-674,共5页
Chinese Journal of Urology
关键词
前列腺肿瘤
转移性
去势抵抗
区域性淋巴结清扫
疗效
并发症
Prostatic neoplasms
Metastatic
Castration resistant
Regional lymph node dissection
Efficacy
Complications
