{"title":"The Prognostic Role of Lymph Node Dissection for High-Risk Localized Prostate Cancer Patients: A Population-Based, Retrospective Cohort Study","authors":"Jieping Hu, Sheng Huang, Yanyan Hong, Weipeng Liu","doi":"10.1007/s12262-024-04153-3","DOIUrl":null,"url":null,"abstract":"<p>The role of lymph node dissection in radical prostatectomy in the survival of patients with clinical N0 high-risk localized prostate cancer, has not yet been elucidated. Patients with high-risk localized prostate cancer who underwent radical prostatectomy ± lymph node dissection were identified in the Surveillance Epidemiology and End Results (SEER) (2010–2015). Patients were divided into two groups: no lymph node dissection (LNN group) and lymph node dissection (LND group). Propensity score matching (PSM) was used to balance the baseline characteristics. Overall survival and cancer-specific survival were analyzed using Kaplan–Meier's method and cox multivariate analyses, and subgroup analyses according to the Gleason score were performed. After PSM, there were 12,309 pairs of White patients in the LNN and LND group, age (odds ratio [OR] = 1.076, 95% confidence interval, CI 1.066–1.087, <i>p</i> < 0.001), Gleason score 7 (OR = 0.542, 95% CI 0.432–0.680, <i>p</i> < 0.001), and Gleason score > 7 (OR = 0.531, 95% CI 0.441–0.640, <i>p</i> < 0.001) were associated with overall survival. Subgroup analysis indicated that LND contributed to a limited 2 months better prognosis for patients with a Gleason score > 7 (101.97 VS 99.33 months, <i>p</i> = 0.013), but not for patients with a Gleason score of 7 (103.90 VS 104.16 months, <i>p</i> = 0.24), comparing to these LNN groups. No significant difference was found in subgroup analysis for the Black population when OS and CSS were compared between the no lymph node dissection and lymph node dissection groups. Patients with high-risk prostate cancer should be carefully selected for lymph node dissection. Only some patients can obtain short-term survival benefits, while other patients cannot benefit from lymph node dissection but have the risk of increased complications.</p>","PeriodicalId":13391,"journal":{"name":"Indian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12262-024-04153-3","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
The role of lymph node dissection in radical prostatectomy in the survival of patients with clinical N0 high-risk localized prostate cancer, has not yet been elucidated. Patients with high-risk localized prostate cancer who underwent radical prostatectomy ± lymph node dissection were identified in the Surveillance Epidemiology and End Results (SEER) (2010–2015). Patients were divided into two groups: no lymph node dissection (LNN group) and lymph node dissection (LND group). Propensity score matching (PSM) was used to balance the baseline characteristics. Overall survival and cancer-specific survival were analyzed using Kaplan–Meier's method and cox multivariate analyses, and subgroup analyses according to the Gleason score were performed. After PSM, there were 12,309 pairs of White patients in the LNN and LND group, age (odds ratio [OR] = 1.076, 95% confidence interval, CI 1.066–1.087, p < 0.001), Gleason score 7 (OR = 0.542, 95% CI 0.432–0.680, p < 0.001), and Gleason score > 7 (OR = 0.531, 95% CI 0.441–0.640, p < 0.001) were associated with overall survival. Subgroup analysis indicated that LND contributed to a limited 2 months better prognosis for patients with a Gleason score > 7 (101.97 VS 99.33 months, p = 0.013), but not for patients with a Gleason score of 7 (103.90 VS 104.16 months, p = 0.24), comparing to these LNN groups. No significant difference was found in subgroup analysis for the Black population when OS and CSS were compared between the no lymph node dissection and lymph node dissection groups. Patients with high-risk prostate cancer should be carefully selected for lymph node dissection. Only some patients can obtain short-term survival benefits, while other patients cannot benefit from lymph node dissection but have the risk of increased complications.
期刊介绍:
The Indian Journal of Surgery is the official publication of the Association of Surgeons of India that considers for publication articles in all fields of surgery. Issues are published bimonthly in the months of February, April, June, August, October and December.
The journal publishes Original article, Point of technique, Review article, Case report, Letter to editor, Teachers and surgeons from the past - A short (up to 500 words) bio sketch of a revered teacher or surgeon whom you hold in esteem and Images in surgery, surgical pathology, and surgical radiology.
A trusted resource for peer-reviewed coverage of all types of surgery
Provides a forum for surgeons in India and abroad to exchange ideas and advance the art of surgery
The official publication of the Association of Surgeons of India
92% of authors who answered a survey reported that they would definitely publish or probably publish in the journal again
The Indian Journal of Surgery offers peer-reviewed coverage of all types of surgery. The Journal publishes Original articles, Points of technique, Review articles, Case reports, Letters, Images and brief biographies of influential teachers and surgeons.
The Journal spans General Surgery, Pediatric Surgery, Neurosurgery, Plastic Surgery, Cardiothoracic Surgery, Vascular Surgery, Rural Surgery, Orthopedic Surgery, Urology, Surgical Oncology, Radiology, Anaesthesia, Trauma Services, Minimal Access Surgery, Endocrine Surgery, GI Surgery, ENT, Colorectal Surgery, surgical practice and research.
The Journal provides a forum for surgeons from India and abroad to exchange ideas, to propagate the advancement of science and the art of surgery and to promote friendship among surgeons in India and abroad. This has been a trusted platform for surgons in communicating up-to-date scientific informeation to the community.