The Prognostic Role of Lymph Node Dissection for High-Risk Localized Prostate Cancer Patients: A Population-Based, Retrospective Cohort Study

IF 0.4 4区 医学 Q4 SURGERY Indian Journal of Surgery Pub Date : 2024-09-06 DOI:10.1007/s12262-024-04153-3
Jieping Hu, Sheng Huang, Yanyan Hong, Weipeng Liu
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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.

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淋巴结清扫对高危局部前列腺癌患者的预后作用:基于人群的回顾性队列研究
淋巴结清扫术在前列腺癌根治术中对临床N0高危局部前列腺癌患者生存率的作用尚未阐明。在监测流行病学和最终结果(SEER)(2010-2015 年)中确定了接受根治性前列腺切除术和淋巴结清扫术的高危局部前列腺癌患者。患者分为两组:无淋巴结清扫组(LNN 组)和淋巴结清扫组(LND 组)。采用倾向评分匹配法(PSM)平衡基线特征。采用 Kaplan-Meier 法和 cox 多变量分析法对总生存率和癌症特异性生存率进行了分析,并根据 Gleason 评分进行了亚组分析。PSM后,LNN组和LND组共有12309对白人患者,年龄(几率比[OR] = 1.076,95%置信区间,CI 1.066-1.087,P < 0.001)、Gleason评分7(OR = 0.542,95% CI 0.432-0.680,p <0.001)和Gleason评分> 7(OR = 0.531,95% CI 0.441-0.640,p <0.001)与总生存率相关。亚组分析表明,与 LNN 组相比,LND 使 Gleason 评分为 7 分的患者的预后提高了 2 个月(101.97 VS 99.33 个月,p = 0.013),但 Gleason 评分为 7 分的患者的预后则没有提高(103.90 VS 104.16 个月,p = 0.24)。在黑人群体的亚组分析中,当比较无淋巴结清扫组和淋巴结清扫组的OS和CSS时,未发现明显差异。高危前列腺癌患者应慎重选择淋巴结清扫术。只有部分患者可获得短期生存益处,而其他患者无法从淋巴结清扫术中获益,但却有增加并发症的风险。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
412
审稿时长
6-12 weeks
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.
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