高危前列腺癌局限和扩大盆腔淋巴结清扫术对比的多中心研究  

A multicenter comparative study of limited and extended pelvic lymph node dissection for high-risk prostate cancer patients

作　　者：危文素 刘皓[2] 李腾成[3] 李永红[1] 杨雪帆 李科[3] 曹云 马华丽 李锴文[2] 林天歆[2] 狄金明[3] 刘小彭[3] 高新[3] 周芳坚[1] 黄健[2] Wei Wensu;Liu Hao;Li Tengcheng;Li Yonghong;Yang Xuefan;Li Ke;Cao Yun;Ma Huali;Li Kaiwen;Lin Tianxin;Di Jinming;Liu Xiaopeng;Gao Xin;Zhou Fangjian;Huang Jian(Department of Urology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Urology,Sun Yat-sen Memorial Hospital,Guangzhou 510120,China;Department of Urology,Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Pathology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Radiology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China)

机构地区：[1]中山大学胖瘤防治中心泌尿外科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060 [2]中山大学孙逸仙纪念医院泌尿外科,广州510120 [3]中山大学附属第三医院泌尿外科,广州510630 [4]中山大学肿瘤防治中心病理科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060 [5]中山大学肿瘤防治中心影像科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060

出　　处：《中华泌尿外科杂志》2021年第9期679-684,共6页Chinese Journal of Urology

摘　　要：目的比较高危前列腺癌患者接受局限性盆腔淋巴结清扫术(LPLND)与扩大盆腔淋巴结清扫术(EPLND)的术后病理结果及并发症情况,探讨盆腔淋巴结阳性的危险因素。方法回顾性分析2016年1月至2020年12月中山大学肿瘤防治中心、中山大学孙逸仙纪念医院和中山大学附属第三医院接受根治性前列腺切除+盆腔淋巴结清扫术的800例高危前列腺癌患者的临床资料。其中172例行LPLND,628例行EPLND。LPLND组患者年龄67(62,72)岁,初诊前列腺特异性抗原(PSA)20.7(10.9,54.8)ng/ml;穿刺Gleason评分6分22例,7分59例,8分56例,9~10分35例;临床分期T_(1)期29例,T_(2)期102例,T_(3)期37例,T_(4)期4例;N_(0)期160例,N_(1)期12例;其中50例行新辅助内分泌治疗。EPLND组患者年龄67(63,72)岁,初诊PSA 23.9(14.0,46.8)ng/ml;穿刺Gleason评分6分51例,7分194例,8分218例,9~10分165例;临床分期T_(1)期114例,T_(2)期341例,T_(3)期144例,T_(4)期29例;N_(0)期526例,N_(1)期102例;其中158例行新辅助内分泌治疗。两组患者的年龄、初诊PSA、穿刺Gleason评分、临床T分期及是否行新辅助内分泌治疗的差异均无统计学意义(P>0.05),临床N分期差异有统计学意义(P=0.002)。分析两组术后淋巴结获取数量、淋巴结阳性率及术后并发症等。采用多因素logistic回归分析患者盆腔淋巴结阳性的危险因素。结果EPLND组中位淋巴结获取数量多于LPLND组[13(8,19)枚与6(4,13)枚,P<0.001],淋巴结阳性率高于LPLND组[31.2%(196/628)与10.5%(18/172),P<0.001]。EPLND组术后总体并发症发生率高于LPLND组[19.9%(125/628)与11.0%(11/172),P=0.007]。初诊PSA值、临床N分期、穿刺Gleason评分和盆腔淋巴结清扫方式是高危前列腺癌患者术后盆腔淋巴结阳性的独立危险因素(均P<0.01)。结论相对于LPLND,高危前列腺癌患者行EPLND可获取更多淋巴结,提高阳性淋巴结检出率,能更准确地进行盆腔淋巴结分期,但是会增加术后并发症发生率。术前PSObjective To compare the pathological results and complications of limited and extended pelvic lymph node dissection among high-risk prostate cancer patients,and to explore the risk factors that affect the rate of lymph node metastasis in high-risk prostate cancer patients.Methods The data of 800 high-risk prostate cancer patients who underwent radical prostatectomy and pelvic lymph node dissection from January 2016 to December 2020 in three affiliated hospital of Sun Yat-sen University were analyzed retrospectively.According to the scope of pelvic lymph node dissection,they were divided into limited pelvic lymph node dissection(LPLND)group and extended pelvic lymph node dissection(EPLND)group.There were 172 patients underwent LPLND,and 628 patients underwent EPLND.The age of the patients in the LPLND group was 67(62,72)years old,diagnosed PSA 20.7(10.9,54.8)ng/ml.The biopsy Gleason score 6 in 22 cases,7 in 59 cases,8 in 56 cases and 9-10 in 35 cases.The clinical T stage:T_(1) in 29 cases,T_(2) in 102 cases,T_(3) in 37 cases,T_(4) in 4 cases;N_(0) in 160 cases and N1 in 12 cases.50 patients received neoadjuvant hormonal therapy.The age of patients in the EPLND group was 67(63,72)years old,diagnosed PSA was 23.9(14.0,46.8)ng/ml.Biopsy Gleason Score 6 in 51 cases,7 in 194 cases,8 in 218 cases and 9-10 in 165 cases.Clinical T stage:T_(1) in 114 cases,T_(2) in 341 cases,T_(3) in 144 cases,T_(4) in 29 cases;N_(0) in 526 cases and N1 in 102 cases.158 patients received neoadjuvant hormonal therapy.There were no significant differences in the age,PSA,puncture Gleason score,clinical T stage,and whether or not to receive neoadjuvant hormonal therapy between the two groups of patients(P>0.05).The difference in clinical N staging was statistically significant(P=0.002).The number of postoperative lymph nodes,positive pelvic lymph nodes and postoperative complications and other related clinical and pathological data of the two groups were analyzed.Multivariate logistic regression was used to analyze the risk factors of patient

关 键 词：前列腺肿瘤 高危 盆腔淋巴结清扫 淋巴结阳性率 并发症 

分 类 号：R737.25[医药卫生—肿瘤]