Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure?
Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure?
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DOI：
10.1097/01.ju.0000049032.38743.c7
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发表时间：
2003-03-01
影响因子：
6.6
通讯作者：
Studer, UE
中科院分区：
文献类型：
--
作者：
Bader, P;Burkhard, FC;Studer, UE
目的：前列腺癌区域淋巴结转移被认为是预后不良的因素。如果进行细致的淋巴结清扫，微转移是否也是如此？我们确定的进展率和生存率的患者与阳性淋巴结根治性切除术后根据数量的transferations.Materials和方法：1989年和1999年之间，367例临床器官局限性前列腺癌进行细致的盆腔淋巴结清扫和根治性切除术。结果：92例（25%）患者有组织学证实的淋巴结转移。88例患者（96%）随访超过1年，中位随访时间为45个月（范围13 - 141）。在19名死于前列腺癌的患者（22%）中，16名患者的阳性淋巴结多于1个。在39例仅有1个阳性淋巴结的患者中，15例（39%）仍然没有临床或化学进展的迹象。而在20例和29例有2个或2个以上阳性淋巴结的患者中，分别只有2例（10%）和4例（14%）保持无病。前列腺特异性抗原复发，症状进展和肿瘤相关死亡的时间显着受阳性nodes.Conclusions的数量影响：MEDIUM淋巴结清扫术揭示了高转移率（25%）。在淋巴结阳性患者中，疾病进展时间与病变淋巴结数量显著相关。一些微小转移性疾病的患者在前列腺切除术后10年以上没有前列腺特异性抗原复发，没有任何辅助治疗。盆腔内侧淋巴结清扫术，尤其是在有微转移的患者中，似乎不仅是一种分期方法，而且对疾病进展和长期无病生存率也有积极影响。
Purpose: In prostate cancer involvement of regional lymph nodes is regarded as a poor prognostic factor. Is this also true for micrometastasis if a meticulous lymph node dissection is performed? We determined progression rate and survival of patients with positive nodes following radical prostatectomy according to the number of metastases.Materials and Methods: Between 1989 and 1999, 367 patients with clinically organ confined prostate cancer underwent meticulous pelvic lymph node dissection and radical prostatectomy. None of the patients received immediate adjuvant therapy.Results: Of the patients 92 (25%) had histologically proven lymph node metastases. Followup of more than 1 year was available in 88 patients (96%), and median followup was 45 months (range 13 to 141). Of 19 patients (22%) who died of prostate cancer 16 had more than I positive node. Of the 39 patients with only 1 positive node 15 (39%) remained without signs of clinical or chemical progression. Whereas of the 20 and 29 patients with 2 or more positive lymph nodes only 2 (10%) and 4 (14%), respectively, remained disease-free. Time to prostate specific antigen relapse, symptomatic progression and tumor related death were significantly affected by the number of positive nodes.Conclusions: Meticulous lymph node dissection reveals a high rate of metastases (25%). In patients with positive nodes time to progression is significantly correlated with the number of diseased nodes. Some patients with minimal metastatic disease remain free of prostate specific antigen relapse for more than 10 years after prostatectomy without any adjuvant treatment. Meticulous pelvic lymph node dissection, particularly in patients with micrometastases, seems not only to be a staging procedure, but may also have a positive impact on disease progression and long-term disease-free survival.