中高危局限性前列腺癌患者扩大盆腔淋巴结清扫的初步临床研究成果分析

doi:10.19558/j.cnki.10-1020/r.2019.05.010

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1155 KB) RICH HTML
输出: BibTeX | EndNote (RIS)

摘要 目的：对中高危局限性前列腺癌患者扩大盆腔淋巴结清扫的淋巴结阳性率进行研究,并探讨影响阳性率的潜在因素。方法：对2014年3月–2018年6月于北京医院行根治性前列腺切除术及扩大盆腔淋巴结清扫术的32例患者资料进行回顾性研究。入组患者均为中高危局限性前列腺癌患者,年龄56~78岁,中位年龄68.5岁。术前PSA 5.17~180.15 μg/L,中位PSA 20.52 μg/L,术前穿刺Gleason评分6~10分,中位评分7分。中危组患者4例,高危组患者28例。对患者先行腹腔镜扩大盆腔淋巴结清扫术,再行前列腺根治性切除术,将所取的淋巴结分区送检。结果：术中共切除淋巴结455枚,每例患者清扫淋巴结6~27枚,中位数12.5枚,32例患者中有4例发现阳性淋巴结,阳性率为12.5%。4例淋巴结阳性患者均来自高危组,术前PSA>20 μg/L且Gleason评分≥7分,术后病理分期pT_3bN₁M₀,其中2例患者阳性淋巴结位于闭孔区域,1例患者分布于闭孔及髂内动脉旁,1例患者分布于闭孔、髂外及髂内动脉旁区域。6例患者出现术后并发症,总并发症发生率为18.75%,其中3例考虑与扩大盆腔淋巴结清扫特异相关,发生率为9.4%。结论：对于中高危局限性前列腺癌患者,穿刺Gleason 评分≥7分、术前PSA>20 μg/L提示更高的淋巴结侵犯可能。中高危局限性前列腺癌患者扩大盆腔淋巴结清扫适应证、其治疗意义以及国内外患者人群的淋巴结转移特点是否存在差异还需要进一步研究证明。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王淼
	刘明
	张伟
	朱生才
	张耀光
	张大磊
	王萱
	王建业

关键词 ：前列腺癌, 淋巴结转, 淋巴结清扫, 前列腺切除术

Abstract：Objective： To determine the incidence of pelvic lymph node involvement and the complication rate of extended pelvic lymphadenectomy in a group of Chinese patients and to investigate the underlying prediction factors. Methods: A total of 32 consecutive patients with intermediate-high risk localized prostate cancer who underwent laparoscopic radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) during March, 2014 and June, 2018 in Beijing Hospital were retrospectively studied. The age of patients ranged from 56-78 years with a median age of 68.5 years. Pre-operation PSA level ranged from 5.17 to 180.15 μg/L with a median level of 20.52 μg/L. The Gleason score ranged from 6 to 10 with the median score of 7. Of those 32 patients, 4 were from intermediate risk group, and 17 were from high risk group. EPLND was performed first before radical prostatectomy. The template of the lymph node dissection included the genitofemoral nerve anterolaterally, the internal iliac artery posteromedially, the bifurcation of the common iliac artery cranially, and the origin of the epigastric vessels caudally. Lymph nodes were sent by separate packages to maximize lymph node inspection. Results: A total of 455 lymph nodes were removed with a median number of lymph nodes removed from each patient of 12.5 (ranging from 6 to 27). Of all 32 patients, 4 were found with lymph node invasion (LNI), giving a positive rate of 12.5%. The four patients with LNI were all from high risk group, with a pre-operation PSA level over 20 μg/L, biopsy Gleason score not less than 7, and a pathologic stage of T_3bN₁M₀. Metastases were identified in all three regions, with two patients within obturator region, one in internal iliac and obturator region and one in internal iliac, external iliac and obturator region. Six patients had complications after surgery, giving a complication rate of 18.75%. Three of these complications have been attributed to nodal dissection, giving a rate of 9.4%. Conclusion: Extended pelvic lymph node dissection at the time of RP is a reliable diagnostic procedure to achieve more pathohistological staging information. It seems that patients from high risk group with a pre-operation PSA level over 20 μg/L, biopsy Gleason score not less than 7 tend to be more likely to have positive lymph nodes detected with ePLND. Further research is required to investigate more accurate positive rate and prediction factors for Chinese patients, as well as the therapeutic role of ePLND.

Key words： prostate neoplasm lymphatic metastases lymph node excision prostatectomy

收稿日期: 2019-01-02

ZTFLH:

R737.25

基金资助:首都临床特色应用研究（Z171100001017201）

通讯作者: 刘明,liuming19731029@163.com

引用本文:

王淼, 刘明, 张伟, 朱生才, 张耀光, 张大磊, 王萱, 王建业. 中高危局限性前列腺癌患者扩大盆腔淋巴结清扫的初步临床研究成果分析[J]. 微创泌尿外科杂志, 2019, 8(5): 334-339.
WANG Miao, LIU Ming, ZHANG Wei, ZHU Shengcai, ZHANG Yaoguang, ZHANG Dalei, WANG Xuan, WANG Jianye. A clinical study on extended pelvic lymph node dissection of Chinese patients with intermediate-high risk localized prostate cancer——An analysis of preliminary data. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(5): 334-339.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1537.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2019/V8/I5/334

[1] MOTTET N, BELLMUNT J, BOLLA M, et al.EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol, 2017,71(4):618-629.
[2] HEIDENREICH A, OHLMANN CH, POLYAKOV S.Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol, 2007,52(1):29-37.
[3] MATTEI A, FUECHSEL FG, BHATTA DHAR N, et al.The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol, 2008,53(1):118-125.
[4] STONE NN, STOCK RG, UNGER P.Laparoscopic pelvic lymph node dissection for prostate cancer: comparison of the extended and modified techniques. J Urol, 1997,158(5):1891-1894.
[5] HEIDENREICH A, VARGA Z, VON KNOBLOCH R.Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol, 2002,167(4):1681-1686.
[6] ALLAF ME, PALAPATTU GS, TROCK BJ, et al.Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol, 2004,172(5 Pt 1):1840-1844.
[7] JOSLYN SA, KONETY BR.Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology, 2006,68(1):121-125.
[8] BADER P, BURKHARD FC, MARKWALDER R, et al.Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol, 2003,169(3):849-854.
[9] BERGLUND RK, SADETSKY N, DUCHANE J, et al.Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urol, 2007,177(2):526-529.
[10] DINDO D, DEMARTINES N, CLAVIEN PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004,240(2):205-213.
[11] HEIDENREICH A.Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymphadenectomy: optimizing a risk-adapted surgical approach. Eur Urol, 2012,61(3):488-490.
[12] BADER P, BURKHARD FC, MARKWALDER R, et al. Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol, 2002,168(2):514-518,discussion 518.
[13] WEINGÄRTNER K, RAMASWAMY A, BITTINGER A, et al. Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol, 1996,156(6):1969-1971.
[14] BRIGANTI A, BLUTE ML, EASTHAM JH, et al.Pelvic lymph node dissection in prostate cancer. Eur Urol, 2009,55(6):1251-1265.
[15] REES T, RAISON N, SHEIKH MI, et al.Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature. Turk J Urol, 2016,42(4):240-246.
[16] BURKHARD FC, STUDER UE.The role of lymphadenectomy in high risk prostate cancer. World J Urol, 2008,26(3):231-236.
[17] HYNDMAN ME, MULLINS JK, PAVLOVICH CP.Pelvic node dissection in prostate cancer: extended, limited, or not at all? Curr Opin Urol, 2010,20(3):211-217.
[18] TOUIJER K, FUENZALIDA RP, RABBANI F, et al.Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity? BJU Int, 2011,108(3):372-377.
[19] BRIGANTI A, CHUN FK, SALONIA A, et al.Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer. BJU Int, 2006,98(4):788-793.
[20] BRIGANTI A, CHUN FK, SALONIA A, et al.Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy. Eur Urol, 2006,49(6):1019-1026.
[21] PICARDO A, VIVIAN J.Extended pelvic lymph node dissection for clinically localized prostate cancer: a West Australian experience. ANZ J Surg, 2015,85(12):936-940.
[22] HEIDENREICH A, PFISTER D, THÜER D, et al. Percentage of positive biopsies predicts lymph node involvement in men with low-risk prostate cancer undergoing radical prostatectomy and extended pelvic lymphadenectomy. BJU Int, 2011,107(2):220-225.
[23] BRIGANTI A, LARCHER A, ABDOLLAH F, et al.Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol, 2012,61(3):480-487.
[24] BRIGANTI A, CHUN FK, SALONIA A, et al.Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol, 2006,50(5):1006-1013.
[25] KEEGAN KA, COOKSON MS.Complications of pelvic lymph node dissection for prostate cancer. Curr Urol Rep, 2011,12(3):203-208.
[26] ROUSSEAU B, DOUCET L, PERROUIN VERBE MA, et al.[Comparison of the morbidity between limited and extended pelvic lymphadenectomy during laparoscopic radical prostatectomy]. Prog Urol, 2014,24(2):114-120.
[27] FOSSATI N, WILLEMSE PM, VAN DEN BROECK T, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol, 2017,72(1):84-109.
[28] MORIZANE S, HONDA M, FUKASAWA S, et al.Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot-assisted radical prostatectomy: a multi-institutional retrospective study in Japan. Int J Clin Oncol, 2018,23(3):568-575.