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Tytuł pozycji:

More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer.

Tytuł:
More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer.
Autorzy:
Abdollah F; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Gandaglia G; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Suardi N; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Capitanio U; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Salonia A; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Nini A; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Moschini M; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Sun M; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada.
Karakiewicz PI; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada.
Shariat SF; Department of Urology, Medical University of Vienna, Vienna, Austria.
Montorsi F; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Briganti A; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: .
Źródło:
European urology [Eur Urol] 2015 Feb; Vol. 67 (2), pp. 212-9. Date of Electronic Publication: 2014 Jun 02.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: 2002- : Amsterdam : Elsevier Science
Original Publication: Basel, New York, Karger.
MeSH Terms:
Lymph Node Excision/*methods
Prostatic Neoplasms/*surgery
Aged ; Antineoplastic Agents, Hormonal/therapeutic use ; Chemotherapy, Adjuvant ; Chi-Square Distribution ; Humans ; Italy ; Kaplan-Meier Estimate ; Lymph Node Excision/adverse effects ; Lymph Node Excision/mortality ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Staging ; Proportional Hazards Models ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/pathology ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Time Factors ; Treatment Outcome
Contributed Indexing:
Keywords: Lymph node dissection; Lymph node invasion; Neoplasm recurrence; Prostatic neoplasms/mortality; Prostatic neoplasms/pathology; Prostatic neoplasms/surgery
Substance Nomenclature:
0 (Antineoplastic Agents, Hormonal)
Entry Date(s):
Date Created: 20140603 Date Completed: 20151217 Latest Revision: 20220330
Update Code:
20240104
DOI:
10.1016/j.eururo.2014.05.011
PMID:
24882672
Czasopismo naukowe
Background: The role of extended pelvic lymph node dissection (ePLND) in treating prostate cancer (PCa) patients with lymph node invasion (LNI) remains controversial.
Objective: The relationship between the number of removed lymph nodes (RLNs) and cancer-specific mortality (CSM) was tested in patients with LNI.
Design, Setting, and Participants: We examined data of 315 pN1 PCa patients treated with radical prostatectomy (RP) and anatomically ePLND between 2000 and 2012 at one tertiary care centre. All patients received adjuvant hormonal therapy with or without adjuvant radiotherapy (aRT).
Outcome Measurements and Statistical Analysis: Univariable and multivariable Cox regression analyses tested the relationship between RLN number and CSM rate, after adjusting to all available covariates. Survival estimates were based on the multivariable model; patients were stratified according to RLN number using points of maximum separation.
Results and Limitations: The average number of RLNs was 20.8 (median: 19; interquartile range: 14-25). Mean and median follow-up were 63.1 and 54 mo, respectively. At 10-yr, the CSM-free survival rate was 74.7%, 85.9%, 92.4%, 96.0%, and 97.9% for patients with 8, 17, 26, 36, and 45 RLNs, respectively. By multivariable analyses, the number of RLNs independently predicted lower CSM rate (hazard ratio [HR]: 0.93; p=0.02). Other predictors of CSM were Gleason score 8-10 (HR: 3.3), number of positive nodes (HR: 1.2), and aRT treatment (HR: 0.26; all p ≤ 0.006). The study is limited by its retrospective nature.
Conclusions: In PCa patients with LNI, the removal of a higher number of LNs during RP was associated with improvement in cancer-specific survival rate. This implies that ePLND should be considered in all patients with a significant preoperative risk of harbouring LNI.
Patient Summary: We found that removing more lymph nodes during prostate cancer surgery can significantly improve cancer-specific survival in patients with lymph node invasion.
(Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Comment in: Eur Urol. 2015 Feb;67(2):220-1; discussion 221-2. (PMID: 25129853)
Comment in: Eur Urol. 2015 Jun;67(6):e112. (PMID: 25282364)
Comment in: Eur Urol. 2015 Aug;68(2):e35-6. (PMID: 25801051)
Comment in: Eur Urol. 2015 Aug;68(2):e37-8. (PMID: 25801052)

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