Background: The therapeutic efficacy of extended lymph node dissection (ePLND) for intermediate- and high-risk (IR/HR) prostate cancer remains controversial. This study evaluated whether PLND improved biochemical recurrence (BCR) rates in patients with prostate cancer undergoing robotic-assisted radical prostatectomy (RARP) using a propensity matching method with cases from two facilities. Methods: The study included 1002 patients with IR/HR disease who underwent RARP at two facilities with equivalent surgical techniques and hospital size but different ePLND policies for IR/HR between July 2012 and November 2022. We compared perioperative outcomes, complications, and biochemical recurrence-free survival (bRFS) between the centers. Results: After propensity matching, 221 and 124 cases, each at intermediate and high risk, respectively, were compared. Except for age, preoperative clinicopathological variables did not differ significantly between the matched ePLND and non-PLND groups. A median of 18 lymph nodes were assessed in the dissection group. The 3-year bRFS rates did not differ significantly between ePLND and non-PLND among intermediate-risk and high-risk patients. The dissection group had significantly longer operative times and more complications associated with ePLND, including lower extremity edema, pelvic hematoma, and neuropathy. A multivariable Cox regression analysis performed after propensity adjustment identified initial prostate-specific antigens, pathological tumor stage (high-risk only), and positive surgical margins as independent prognostic factors for bRFS while ePLND was not significant. Conclusions: These results suggest that ePLND may not be necessary in intermediate- to high-risk PCa patients undergoing RARP, although further study with a longer follow-up is required.
背景：对于中高危前列腺癌患者，扩大淋巴结清扫术的治疗效果仍存在争议。本研究采用倾向性匹配方法，对来自两家医疗机构的病例进行分析，评估了在接受机器人辅助根治性前列腺切除术的患者中，淋巴结清扫是否改善了生化复发率。方法：研究纳入了2012年7月至2022年11月期间，在两家手术技术及医院规模相当但中高危患者淋巴结清扫策略不同的医疗机构接受机器人辅助根治性前列腺切除术的1002例中高危前列腺癌患者。我们比较了两家中心的围手术期结果、并发症及无生化复发生存率。结果：经过倾向性匹配后，分别对221例中危患者和124例高危患者进行了比较。除年龄外，匹配后的扩大淋巴结清扫组与非清扫组在术前临床病理变量上无显著差异。清扫组中位淋巴结检出数量为18枚。在中危和高危患者中，扩大淋巴结清扫组与非清扫组的3年无生化复发生存率无显著差异。清扫组手术时间显著更长，且与扩大淋巴结清扫相关的并发症（如下肢水肿、盆腔血肿和神经病变）更多。倾向性调整后的多变量Cox回归分析显示，初始前列腺特异性抗原水平、病理肿瘤分期（仅高危患者）以及手术切缘阳性是无生化复发生存率的独立预后因素，而扩大淋巴结清扫并非显著影响因素。结论：这些结果表明，对于接受机器人辅助根治性前列腺切除术的中高危前列腺癌患者，扩大淋巴结清扫可能并非必要，但仍需更长时间的随访研究进一步验证。
肿瘤(癌症)患者之家