Abstract：
BACKGROUND: Some authors propose extended pelvic lymph node dissection (ePLND) to enhance diagnostic and therapeutic outcomes in patients with localized prostate cancer. However, recent evidence found no difference in biochemical recurrence (BCR).
OBJECTIVE: To stratify and analyze available evidence on ePLND and its impact on BCR in patients with localized prostate cancer.
METHODS: We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies up to November 2023. We identified original articles that presented statistical comparisons through Cox regressions reported as hazard ratio (HR) or survival curve data reported as Kaplan-Meier curve differences in BCR in patients undergoing radical prostatectomy and stratified by the extent of lymph node dissection for localized prostate cancer.
RESULTS: We identified 12 studies, with two being randomized controlled trials (RCTs). The RCTs showed no benefit of ePLND with an HR of 1.03 ([0.92, 1.14], p = 0.61). A combined analysis with the ten retrospective studies revealed a notable reduction in BCR with an HR of 0.68 ([0.52, 0.88], p = 0.003). A subgroup analysis based on the extent of dissection demonstrated that studies focusing on the more conservative extended template of dissection did not show significant BCR benefit (HR 0.97 [0.72, 1.32], p = 0.86). In contrast, dissections that expanded the anatomical extent showed decreased BCR (HR 0.56 [0.41, 0.75], p < 0.0001). A Bayesian network analysis highlights significant differences in BCR reduction between different dissection approaches, indicating the potential benefits of specific dissection templates.
CONCLUSIONS: Available literature on the extent of pelvic lymph node dissection needs to be improved in quality and varying definitions of the ePLND template. Dissection of the common iliac nodes may be beneficial.
RESULTS: There is a potential benefit in removing more lymph nodes during radical prostatectomy. However, more research is needed to determine whether this strategy benefits certain patient groups.
OBJECTIVE: To stratify and analyze available evidence on ePLND and its impact on BCR in patients with localized prostate cancer.
METHODS: We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies up to November 2023. We identified original articles that presented statistical comparisons through Cox regressions reported as hazard ratio (HR) or survival curve data reported as Kaplan-Meier curve differences in BCR in patients undergoing radical prostatectomy and stratified by the extent of lymph node dissection for localized prostate cancer.
RESULTS: We identified 12 studies, with two being randomized controlled trials (RCTs). The RCTs showed no benefit of ePLND with an HR of 1.03 ([0.92, 1.14], p = 0.61). A combined analysis with the ten retrospective studies revealed a notable reduction in BCR with an HR of 0.68 ([0.52, 0.88], p = 0.003). A subgroup analysis based on the extent of dissection demonstrated that studies focusing on the more conservative extended template of dissection did not show significant BCR benefit (HR 0.97 [0.72, 1.32], p = 0.86). In contrast, dissections that expanded the anatomical extent showed decreased BCR (HR 0.56 [0.41, 0.75], p < 0.0001). A Bayesian network analysis highlights significant differences in BCR reduction between different dissection approaches, indicating the potential benefits of specific dissection templates.
CONCLUSIONS: Available literature on the extent of pelvic lymph node dissection needs to be improved in quality and varying definitions of the ePLND template. Dissection of the common iliac nodes may be beneficial.
RESULTS: There is a potential benefit in removing more lymph nodes during radical prostatectomy. However, more research is needed to determine whether this strategy benefits certain patient groups.
摘要：
背景：一些作者提出扩大盆腔淋巴结清扫术（ePLND）以提高局限性前列腺癌患者的诊断和治疗效果。然而,最近的证据发现生化复发（BCR）没有差异。
目的：对有关ePLND及其对局限性前列腺癌患者BCR的影响的现有证据进行分层和分析。
方法：我们根据系统审查和荟萃分析（PRISMA）指南的首选报告项目对文献进行了系统审查，以确定截至2023年11月的研究。我们确定了原始文章，这些文章通过Cox回归报告为风险比（HR）或生存曲线数据报告为接受根治性前列腺切除术的患者BCR的Kaplan-Meier曲线差异，并根据淋巴结清扫的程度对局限性前列腺癌进行分层。
结果：我们确定了12项研究，其中两项为随机对照试验（RCT）。RCT没有显示ePLND的益处，HR为1.03([0.92，1.14]，p=0.61）。与十项回顾性研究的综合分析显示，BCR显着降低，HR为0.68（[0.52，0.88]，p=0.003)。基于解剖程度的亚组分析表明，专注于更保守的解剖扩展模板的研究并未显示出明显的BCR益处（HR0.97[0.72,1.32]，p=0.86）。相比之下,扩大解剖范围的解剖显示BCR降低(HR0.56[0.41，0.75]，p<0.0001)。贝叶斯网络分析强调了不同解剖方法在BCR减少方面的显著差异，表明特定解剖模板的潜在好处。
结论：关于盆腔淋巴结清扫程度的现有文献需要改进ePLND模板的质量和不同定义。髂总淋巴结的解剖可能是有益的。
结果：在根治性前列腺切除术中切除更多的淋巴结有潜在的益处。然而,需要更多的研究来确定这种策略是否有利于某些患者群体.
目的：对有关ePLND及其对局限性前列腺癌患者BCR的影响的现有证据进行分层和分析。
方法：我们根据系统审查和荟萃分析（PRISMA）指南的首选报告项目对文献进行了系统审查，以确定截至2023年11月的研究。我们确定了原始文章，这些文章通过Cox回归报告为风险比（HR）或生存曲线数据报告为接受根治性前列腺切除术的患者BCR的Kaplan-Meier曲线差异，并根据淋巴结清扫的程度对局限性前列腺癌进行分层。
结果：我们确定了12项研究，其中两项为随机对照试验（RCT）。RCT没有显示ePLND的益处，HR为1.03([0.92，1.14]，p=0.61）。与十项回顾性研究的综合分析显示，BCR显着降低，HR为0.68（[0.52，0.88]，p=0.003)。基于解剖程度的亚组分析表明，专注于更保守的解剖扩展模板的研究并未显示出明显的BCR益处（HR0.97[0.72,1.32]，p=0.86）。相比之下,扩大解剖范围的解剖显示BCR降低(HR0.56[0.41，0.75]，p<0.0001)。贝叶斯网络分析强调了不同解剖方法在BCR减少方面的显著差异，表明特定解剖模板的潜在好处。
结论：关于盆腔淋巴结清扫程度的现有文献需要改进ePLND模板的质量和不同定义。髂总淋巴结的解剖可能是有益的。
结果：在根治性前列腺切除术中切除更多的淋巴结有潜在的益处。然而,需要更多的研究来确定这种策略是否有利于某些患者群体.
