{"title":"骨盆淋巴结清扫在机器人辅助根治性前列腺切除术中的治疗作用","authors":"Ryosuke Yamase, Satoshi Yamamoto, Koki Watanabe, Atsushi Inoue, Kazuyoshi Nakamura, Maki Nagata","doi":"10.1111/ases.70061","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Extended pelvic lymph node dissection (PLND) is recommended for intermediate- and high-risk prostate cancer according to D'Amico risk classification, and there is evidence supporting its diagnostic value in staging. However, its therapeutic benefit remains unproven. We, therefore, aimed to evaluate the therapeutic significance of PLND in patients undergoing robot-assisted radical prostatectomy (RARP).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively analyzed 329 patients with intermediate- or high-risk prostate cancer (per D'Amico risk classification) who underwent RARP at two centers. Patients were divided into two groups: those who did not undergo lymph node dissection (no-PLND group) and those who underwent an extended PLND (extended-PLND group). After excluding patients who received neoadjuvant hormone therapy, 313 cases remained for analysis. Propensity score matching was performed to balance baseline characteristics, yielding 85 matched pairs. We compared prostate-specific antigen progression-free survival (PSA-PFS) and overall survival (OS) between the matched groups. Perioperative outcomes (complications, console time, and blood loss) were also compared.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Kaplan–Meier analysis showed no significant differences in PSA-PFS (<i>p</i> = 0.163) or OS (<i>p</i> = 0.323) between the extended-PLND and no-PLND groups after matching. Similarly, when stratified by risk category, PSA-PFS did not differ significantly between the two groups for either intermediate-risk or high-risk patients. Perioperative blood loss was similar between groups, but the no-PLND group had a significantly lower overall complication rate (5.1% vs. 30.4%, <i>p</i> < 0.001) and shorter median console time (160.2 vs. 230.5 min, <i>p</i> < 0.001) than the extended-PLND group. Notably, no Grade 3–4 complications (Clavien–Dindo) occurred in the no-PLND group, compared to 11 cases in the extended-PLND group.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>In intermediate- and high-risk prostate cancer, performing an extended PLND during RARP did not improve biochemical recurrence-free or OS, suggesting minimal therapeutic benefit.</p>\n </section>\n </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70061","citationCount":"0","resultStr":"{\"title\":\"Reevaluating the Therapeutic Role of Pelvic Lymph Node Dissection in Robot-Assisted Radical Prostatectomy\",\"authors\":\"Ryosuke Yamase, Satoshi Yamamoto, Koki Watanabe, Atsushi Inoue, Kazuyoshi Nakamura, Maki Nagata\",\"doi\":\"10.1111/ases.70061\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Extended pelvic lymph node dissection (PLND) is recommended for intermediate- and high-risk prostate cancer according to D'Amico risk classification, and there is evidence supporting its diagnostic value in staging. However, its therapeutic benefit remains unproven. We, therefore, aimed to evaluate the therapeutic significance of PLND in patients undergoing robot-assisted radical prostatectomy (RARP).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We retrospectively analyzed 329 patients with intermediate- or high-risk prostate cancer (per D'Amico risk classification) who underwent RARP at two centers. Patients were divided into two groups: those who did not undergo lymph node dissection (no-PLND group) and those who underwent an extended PLND (extended-PLND group). After excluding patients who received neoadjuvant hormone therapy, 313 cases remained for analysis. Propensity score matching was performed to balance baseline characteristics, yielding 85 matched pairs. We compared prostate-specific antigen progression-free survival (PSA-PFS) and overall survival (OS) between the matched groups. Perioperative outcomes (complications, console time, and blood loss) were also compared.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Kaplan–Meier analysis showed no significant differences in PSA-PFS (<i>p</i> = 0.163) or OS (<i>p</i> = 0.323) between the extended-PLND and no-PLND groups after matching. Similarly, when stratified by risk category, PSA-PFS did not differ significantly between the two groups for either intermediate-risk or high-risk patients. Perioperative blood loss was similar between groups, but the no-PLND group had a significantly lower overall complication rate (5.1% vs. 30.4%, <i>p</i> < 0.001) and shorter median console time (160.2 vs. 230.5 min, <i>p</i> < 0.001) than the extended-PLND group. Notably, no Grade 3–4 complications (Clavien–Dindo) occurred in the no-PLND group, compared to 11 cases in the extended-PLND group.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>In intermediate- and high-risk prostate cancer, performing an extended PLND during RARP did not improve biochemical recurrence-free or OS, suggesting minimal therapeutic benefit.</p>\\n </section>\\n </div>\",\"PeriodicalId\":47019,\"journal\":{\"name\":\"Asian Journal of Endoscopic Surgery\",\"volume\":\"18 1\",\"pages\":\"\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2025-04-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70061\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Journal of Endoscopic Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/ases.70061\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Journal of Endoscopic Surgery","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ases.70061","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
扩展盆腔淋巴结清扫术（Extended pelvic lymph node dissection， PLND）是根据D’amico风险分类推荐用于中高危前列腺癌的治疗，有证据支持其分期诊断价值。然而，其治疗效果尚未得到证实。因此，我们旨在评估PLND在接受机器人辅助根治性前列腺切除术（RARP）患者中的治疗意义。方法我们回顾性分析了329例在两个中心接受RARP治疗的中高危前列腺癌患者（按D'Amico风险分类）。患者分为两组：未行淋巴结清扫（no-PLND组）和行延长淋巴结清扫（extended-PLND组）。在排除接受新辅助激素治疗的患者后，仍有313例病例有待分析。进行倾向评分匹配以平衡基线特征，产生85对匹配。我们比较了匹配组之间的前列腺特异性抗原无进展生存期（PSA-PFS）和总生存期（OS）。围手术期结果（并发症、控制台时间和出血量）也进行了比较。结果Kaplan-Meier分析显示，配对后延长plnd组与未延长plnd组的PSA-PFS （p = 0.163）和OS （p = 0.323）差异无统计学意义。同样，当按风险类别分层时，两组之间无论是中危患者还是高危患者的PSA-PFS均无显著差异。两组围手术期出血量相似，但无plnd组的总并发症发生率明显低于延长plnd组（5.1% vs. 30.4%, p < 0.001），中位安慰时间较短（160.2 vs. 230.5 min, p < 0.001）。值得注意的是，无plnd组没有发生3-4级并发症（Clavien-Dindo），而延长plnd组有11例。结论：对于中高危前列腺癌，在RARP期间进行延长的PLND并不能改善生化无复发或OS，表明治疗效果极小。
Reevaluating the Therapeutic Role of Pelvic Lymph Node Dissection in Robot-Assisted Radical Prostatectomy
Introduction
Extended pelvic lymph node dissection (PLND) is recommended for intermediate- and high-risk prostate cancer according to D'Amico risk classification, and there is evidence supporting its diagnostic value in staging. However, its therapeutic benefit remains unproven. We, therefore, aimed to evaluate the therapeutic significance of PLND in patients undergoing robot-assisted radical prostatectomy (RARP).
Methods
We retrospectively analyzed 329 patients with intermediate- or high-risk prostate cancer (per D'Amico risk classification) who underwent RARP at two centers. Patients were divided into two groups: those who did not undergo lymph node dissection (no-PLND group) and those who underwent an extended PLND (extended-PLND group). After excluding patients who received neoadjuvant hormone therapy, 313 cases remained for analysis. Propensity score matching was performed to balance baseline characteristics, yielding 85 matched pairs. We compared prostate-specific antigen progression-free survival (PSA-PFS) and overall survival (OS) between the matched groups. Perioperative outcomes (complications, console time, and blood loss) were also compared.
Results
Kaplan–Meier analysis showed no significant differences in PSA-PFS (p = 0.163) or OS (p = 0.323) between the extended-PLND and no-PLND groups after matching. Similarly, when stratified by risk category, PSA-PFS did not differ significantly between the two groups for either intermediate-risk or high-risk patients. Perioperative blood loss was similar between groups, but the no-PLND group had a significantly lower overall complication rate (5.1% vs. 30.4%, p < 0.001) and shorter median console time (160.2 vs. 230.5 min, p < 0.001) than the extended-PLND group. Notably, no Grade 3–4 complications (Clavien–Dindo) occurred in the no-PLND group, compared to 11 cases in the extended-PLND group.
Conclusion
In intermediate- and high-risk prostate cancer, performing an extended PLND during RARP did not improve biochemical recurrence-free or OS, suggesting minimal therapeutic benefit.
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