文章：

根治性前列腺切除术后淋巴结阳性患者治疗方案的叙事性综述：现有证据与争议

A Narrative Review of Treatment Options for Patients with Node-Positive Disease After Radical Prostatectomy: Current Evidence and Controversies

原文发布日期：27 August 2025

DOI: 10.3390/cancers17172792

类型: Article

开放获取: 是

英文摘要：

Purpose of Review: In approximately 10–15% of patients with prostate cancer (PCa), pathological lymph node metastases (pN1) are detected at radical prostatectomy (RP). The aim of this review is to describe the various treatment options for pN1 patients, with a focus on the most recent evidence reported in the literature.Evidence Synthesis: Due to the lack of prospective studies, several retrospective analyses were conducted according to different types of treatment. Most common strategies are represented by observation plus early salvage radiotherapy (RT) in case of PSA rising, adjuvant androgen deprivation therapy (ADT) alone, or adjuvant RT with or without ADT. Patients with pN1 disease and favorable disease characteristics (lower T stage and ISUP ≤ 2 at RP, <3 metastatic nodes at pathology) have a similar overall mortality risk if observed with PSA testing and eventual use of early salvage RT compared to patients directly treated with adjuvant RT with or without ADT. While conflicting results in terms of survival benefit were reported for the use of adjuvant ADT only, several studies showed an overall survival benefit in patients with pN1 disease treated with adjuvant RT when high-risk features (such as an increasing number of positive nodes, ISUP > 3) were detected at RP. Lastly, few studies analyzed the rate of adverse events following adjuvant ADT or RT, leaving the issue of treatment-related side effects still open.Summary: There is no clearly established standard of care for men with pN1 PCa, and disease characteristics should guide the choice of optimal post-operative management for these patients. Prospective data and clinical trials are clearly needed to define the most effective therapeutic strategy.

摘要翻译： 

综述目的：约10-15%的前列腺癌（PCa）患者在根治性前列腺切除术（RP）中检出病理淋巴结转移（pN1）。本综述旨在阐述pN1患者的多种治疗方案，重点关注文献报道的最新证据。 证据综合：由于缺乏前瞻性研究，现有证据主要基于不同治疗方式的回顾性分析。最常见的策略包括：观察联合PSA升高时的早期挽救性放疗（RT）、单纯辅助雄激素剥夺疗法（ADT）、或辅助RT联合/不联合ADT。对于具有有利疾病特征（RP时T分期较低且ISUP≤2级、病理转移淋巴结<3个）的pN1患者，采用PSA监测并适时进行早期挽救性RT的观察策略，与直接接受辅助RT（联合/不联合ADT）的患者相比，总体死亡风险相似。虽然单纯辅助ADT的生存获益存在争议，但多项研究表明当RP检出高风险特征（如阳性淋巴结数量增加、ISUP>3级）时，pN1患者接受辅助RT可获得总生存获益。最后，目前仅有少数研究分析了辅助ADT或RT后的不良事件发生率，治疗相关副作用问题仍有待探讨。 总结：目前pN1前列腺癌患者尚无明确的标准治疗方案，临床决策应基于疾病特征制定个体化术后管理策略。未来亟需前瞻性数据和临床试验来确定最有效的治疗策略。

原文链接：

A Narrative Review of Treatment Options for Patients with Node-Positive Disease After Radical Prostatectomy: Current Evidence and Controversies