Extensive pelvic lymph node dissection and radical prostatectomy in the treatment of locally advanced prostate cancer with 10 years experiences: a follow-up of 246 cases

doi:10.3877/cma.j.issn.1674-3253.2022.02.002

Abstract

Abstract:

Objective

The long-term follow-up results of patients with locally advanced prostate cancer (LAPC) treated with laparoscopic extensive pelvic lymph node dissection combined with radical prostatectomy (ePLND+LRP) are still rare. This study reports 246 LAPC patients treated with ePLND+LRP from 2006 to 2020 in the Third Affiliated Hospital of Sun Yat-sen University.

Methods

From October 2006 to October 2020, 246 LAPC patients with ePLND+LRP were enrolled in this study. The operation time, blood loss, duration of hospital stay and complications, oncology results, and adjuvant treatments occurred within 30 days after surgery were collected.

Results

The median age was 70(65-74) years; the median PSA was 24(10-60) ng/ml. The median operation time, blood loss, and hospital stay were 217 minutes, 170 ml, and 7 days, respectively. In pathological staging, there were 28 cases (11.4%) in pT₂, 117 cases (47.6%) in pT_3a, 92 cases (37.4%) in pT_3b, and 9 cases (3.7%) in pT₄. The median number of lymph nodes dissected was 21(13-27), and the median number of positive lymph nodes was 2(1-3). 48(19.5%) and 31(12.6%) patients had positive lymph nodes and positive surgical margins. Thirty-eight(15.4%) patients experienced complications, of which 17 cases (6.9%) were classified as Clavien I, 19 cases (7.7%) were classified as Clavien II, and 2 cases (0.8%) were classified as Clavien III. The median follow-up time was 127.8 months, during the follow-up period, 23(9.3%), 219(89.0%), 59(24.0%), and 7(2.8%) patients received adjuvant radiotherapy (RT), hormone therapy (HT), and salvage lymph node dissection (sLND), salvage local treatment. The 10-year BCR-free survival and metastasis-free survival (MFS) rates were 58.5%(144/246) and 73.6%(181/246), respectively. Cancer-specific survival (CSS) and overall survival (OS) were 91.6% and 85.3%, respectively. The rate of urinary control at one year after operation was 96.7%.

Conclusion

The ePLND+LRP treatment of LAPC has fewer complications and a good tumor control effect. It is safe and effective as the initial treatment of LAPC.

Key words: Long-term follow-up, Oncology results, Prostate cancer, Prostatectomy, Lymph node dissection

Yu Wang, Zhuolun Sun, Tengcheng Li, Xiaopeng Liu, Ke Li, Cheng Hu, Youqiang Fang, Liaoyuan Li, Jinming Di, Xin Gao. Extensive pelvic lymph node dissection and radical prostatectomy in the treatment of locally advanced prostate cancer with 10 years experiences: a follow-up of 246 cases[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(02): 101-105.

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References 17

[1]	Conachiu S, Predoiu G, Danau R, et al. The complications of radical prostatectomy for locally advanced prostate cancer [J]. Eur Urol Suppl, 2019, 18(2):e2324.
[2]	高新, 江东根, 黄群雄, 等. 根治性前列腺联合扩大盆腔淋巴结清扫术治疗局部高危前列腺癌12年经验总结[J]. 中华泌尿外科杂志, 2017, 38(6): 433-437.
[3]	马春光, 叶定伟, 李长岭, 等. 前列腺癌的流行病学特征及晚期一线内分泌治疗 [J]. 中华外科杂志, 2008, 46(12): 921-925.
[4]	Zhuang J, Qiu X, Zhang S, et al. Evaluation of neoadjuvant chemohormonal therapy before radical prostatectomy in patients with high-risk and locally advanced prostate cancer: A prospective study of goserelin and bicalutamide with or without docetaxel[J]. Eur Urol Open Science, 2020, 19(Supplement 2): e1044.
[5]	高新. 拯救性淋巴结清扫术治疗前列腺癌根治术后淋巴结转移[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(2): 73-75.
[6]	Faria EF, Chapin BF, Muller RL, et al. Radical prostatectomy for locally advanced prostate cancer: current status [J]. Urology, 2015, 86(1): 10-15.
[7]	Ghabili K, Park HS, Yu JB, et al. National trends in the management of patients with positive surgical margins at radical prostatectomy[J]. World J Urol, 2021, 39(4): 1141-1151.
[8]	Freedland SJ, Partin AW, Humphreys EB, et al. Radical prostatectomy for clinical stage T3a disease[J]. Cancer, 2007, 109(7): 1273-1278.
[9]	方友强, 周祥福. 2020版美国国立综合癌症网络前列腺癌临床实践指南要点解读[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(6): 405-408.
[10]	方友强, 周祥福. 2020版欧洲泌尿外科学会前列腺癌诊疗指南更新要点解读[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(6): 401-404.
[11]	van den Ouden D, Bentvelsen FM, Boevé ER, et al. Positive margins after radical prostatectomy: correlation with local recurrence and distant progression[J]. Br J Urol. 72(4): 489-494.
[12]	Nguyen DP, Huber PM, Metzger TA, et al. A Specific mapping study using fluorescence sentinel lymph node detection in patients with intermediate- and high-risk prostate cancer undergoing extended pelvic lymph node dissection [J]. Eur Urol, 2016, 70(5): 734-737.
[13]	Gao Xin, Li LiaoYuan, Jörg Rassler, et al. Prospective study ofcrmp4promoter methylation in prostate biopsies as a predictor for lymph node metastases [J]. J Natl Cancer Inst, 2017, 109(6): 282.
[14]	王喻,温星桥,李名钊,等. 荧光腹腔镜与高清腹腔镜根治性前列腺切除术+扩大盆腔淋巴结清扫治疗局部高危前列腺癌的疗效对比[J]. 中华泌尿外科杂志, 2019, 40(3): 161-166.
[15]	王喻, 梁伟聪, 孙卓伦, 等. 荧光显像腹膜后淋巴结清扫在根治性前列腺切除术后淋巴结复发患者中的应用价值[J]. 中华泌尿外科杂志, 2021, 42(9): 666-669.
[16]	Ghabili K, Park HS, Yu JB, et al. National trends in the management of patients with positive surgical margins at radical prostatectomy [J]. World J Urol, 2021, 39(4): 1141-1151.
[17]	王喻,梁伟聪,高新. 荧光靶向造影剂在机器人辅助根治性前列腺切除及盆腔前哨淋巴结清扫术中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(5): 362-366.

参数		值
年龄（岁）		70（65~74）
PSA（ng/ml）		24（10~60）
cT（例）
	≤cT_3a	138
	cT_3b	102
	cT₄	6
穿刺活检ISUP分级（例）
	≤3	11
	4	133
	5	102
淋巴结（例）
	N₀	179
	N₁	61
中位手术时间（min）		217（192~302）
失血量（ml）		170（50~300）
并发症（例）		38
Clavien Ⅰ		17
Clavien Ⅱ		19
Claivien Ⅲ		2
中位住院时间（d）pT≤pT_3a		7（5~14）
中位住院时间（d）pT≤pT_3a		101
	pT_3b	138
	pT₄	17
	pN（例）
	pN₀	158
	pN₁	88
术后ISUP分级（例）
	≤3	3
	4	132
	5	111
生化复发率（例）		102
临床复发（转移）		65

参数		值
年龄（岁）		70（65~74）
PSA（ng/ml）		24（10~60）
cT（例）
	≤cT_3a	138
	cT_3b	102
	cT₄	6
穿刺活检ISUP分级（例）
	≤3	11
	4	133
	5	102
淋巴结（例）
	N₀	179
	N₁	61
中位手术时间（min）		217（192~302）
失血量（ml）		170（50~300）
并发症（例）		38
Clavien Ⅰ		17
Clavien Ⅱ		19
Claivien Ⅲ		2
中位住院时间（d）pT≤pT_3a		7（5~14）
中位住院时间（d）pT≤pT_3a		101
	pT_3b	138
	pT₄	17
	pN（例）
	pN₀	158
	pN₁	88
术后ISUP分级（例）
	≤3	3
	4	132
	5	111
生化复发率（例）		102
临床复发（转移）		65

	单因素分析			多因素分析
	HR	95%CI	P值	HR	5%CI	P值
年龄	0.631	0.347~1.032	<0.051
诊断时PSA	1.278	1.194~1.789	<0.037	1.092	0.918~1.329	<0.045
穿刺Gleason评分	1.621	1.218~2.133	<0.031	1.291	1.033~1.921	<0.061
T分期	1.321	1.117~1.821	<0.019	1.519	1.092~1.712	<0.059
清扫淋巴结数目	1.113	1.097~2.145	<0.027	1.428	1.191~1.982	<0.037
阳性淋巴结数目	3.231	2.549~4.187	<0.001	4.517	3.278~4.618	<0.001
术后Gleason评分	1.841	1.372~2.731	<0.001	2.143	1.729~2.712	<0.001
术后T分期	1.521	1.219~2.981	<0.001	1.329	1.132~2.120	<0.035
切缘阳性	2.145	1.783~2.321	<0.001	1.286	1.096~1.541	<0.051
术后PSA最低值	1.312	1.098~1.912	<0.029	1.092	0.812~1.231	<0.071
术后PSA最低值时间	0.354	0.215~1.091	<0.561	0.519	0.349~0.718	<0.069
辅助内分泌治疗	0.398	0.278~0.417	<0.001	1.716	1.378~2.142	<0.001

	单因素分析			多因素分析
	HR	95%CI	P值	HR	5%CI	P值
年龄	0.631	0.347~1.032	<0.051
诊断时PSA	1.278	1.194~1.789	<0.037	1.092	0.918~1.329	<0.045
穿刺Gleason评分	1.621	1.218~2.133	<0.031	1.291	1.033~1.921	<0.061
T分期	1.321	1.117~1.821	<0.019	1.519	1.092~1.712	<0.059
清扫淋巴结数目	1.113	1.097~2.145	<0.027	1.428	1.191~1.982	<0.037
阳性淋巴结数目	3.231	2.549~4.187	<0.001	4.517	3.278~4.618	<0.001
术后Gleason评分	1.841	1.372~2.731	<0.001	2.143	1.729~2.712	<0.001
术后T分期	1.521	1.219~2.981	<0.001	1.329	1.132~2.120	<0.035
切缘阳性	2.145	1.783~2.321	<0.001	1.286	1.096~1.541	<0.051
术后PSA最低值	1.312	1.098~1.912	<0.029	1.092	0.812~1.231	<0.071
术后PSA最低值时间	0.354	0.215~1.091	<0.561	0.519	0.349~0.718	<0.069
辅助内分泌治疗	0.398	0.278~0.417	<0.001	1.716	1.378~2.142	<0.001

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